SCIENCE FICTION FOR GREECE

NEW YORK (Reuters Health) Feb 25 - Removal of para-aortic and pelvic lymph nodes in endometrial cancer patients may be linked with better overall survival than pelvic lymphadenectomy alone, Japanese researchers report in the February 25th online issue of The Lancet.

Pelvic lymphadenectomy for staging of endometrial cancer does not seem to offer any therapeutic benefits, but whether adding para-aortic lymphadenectomy might be beneficial has not been studied, according to senior author Dr. Noriaki Sakuragi, from Hokkaido University Graduate School of Medicine, Sapporo, and colleagues.

In a retrospective cohort study, the investigators analyzed data on endometrial cancer patients treated at two centers from 1986 to 2004, including 325 who had pelvic lymphadenectomy only and 346 who had both pelvic and para-aortic lymphadenectomy.

The two groups were generally similar, although more women in the pelvic node only group received radiotherapy and more in the pelvic plus para-aortic node group received chemotherapy.

Pelvic plus para-aortic node removal cut the risk of death during follow-up by 47% (p = 0.0005), the authors said. Further analysis showed that the survival benefit was only statistically significant in patients with an intermediate or high risk of recurrence (HR, 0.44, p <>

When the analysis was confined to the 328 intermediate- and high-risk patients who received adjuvant therapy, two factors emerged as independent predictors of survival: pelvic plus para-aortic node removal (HR, 0.48, p = 0.0049) and chemotherapy (HR, 0.59, p = 0.0465).

In an editorial, Dr. Sean C. Dowdy and Dr. Andrea Mariani, from the Mayo Clinic, Rochester, Minnesota, agree with the authors that a randomized trial is now needed to confirm the study findings. They go on to list four elements the trial should contain: a focus on patients at high risk of recurrence, standard-of-care treatments for patients in the non-lymphadenectomy control group, pelvic plus para-aortic node removal in the intervention group, and use of lymph node status to direct postoperative care.

Lancet 2010.