Survival outcomes in sentinel node-positive vs. -negative endometrial cancer following adjustment for uterine risk factors: a propensity score-matched analysis (TRSGO-SLN-011)

Abstract

Objective: To evaluate the association between sentinel lymph node status and survival outcomes in cases of endometrial cancer and to identify prognostic factors. Methods: Our multicenter retrospective study included 1473 cases of clinically early-stage endometrial cancer evaluated by sentinel lymph node mapping between 2014 and 2023. After excluding 89 cases due to missing data, 1384 cases were analyzed, including 1282 patients found to have negative sentinel lymph nodes and 102 with positive sentinel lymph nodes. Propensity score matching (1:1) was performed using histological subtypes, tumor grades, myometrial invasion depths, and lymphovascular space and cervical stromal invasion statuses. Of the 102 patients found to have sentinel lymph node positivity, 73 were successfully matched to 73 patients from the negative group. Results: After a median follow-up duration of 52 months, no statistical difference was noted between patients with positive and negative sentinel lymph nodes for 5-year disease-free survival (60.3% and 78.6%, respectively; p = 0.162) or 5-year overall survival (71.1% and 86.7%; p = 0.255). Multivariable analysis indicated that tumor grade 3 could independently predict decreased disease-free survival (HR: 3.04; 95% CI: 1.37-6.74; p = 0.006). However, no independent prognostic factors were determined for overall survival. Conclusion: After adjustment for uterine risk factors, sentinel lymph node status was no statistically significant independent association detected with survival outcomes. Prognosis was found to be shaped by an integrated set of uterine risk factors that included sentinel lymph node status, highlighting the need to individualize adjuvant treatment according to the complete tumor risk profile.