Endometriyal Kanserde Sistematik Lenfadenektominin Terapötik Rolü ve Sağkalım Üzerine Etkisi: Retrospektif Kohort Çalışması

Abstract

Bu çalışmanın amacı, endometrioid endometriyal kanserli hastalarda sistematik lenfadenektominin terapötik ve prognostik rolünü değerlendirmektir. Çalışmaya, Ocak 2010 ile Mayıs 2025 arasında üçüncü basamak bir üniversite hastanesinde primer cerrahi tedavi uygulanmış FIGO 2009 evre I–III endometrioid endometriyal karsinom tanılı 512 hasta dahil edildi. Hastalar, lenfadenektomi uygulanıp uygulanmadığına göre kategorize edildi. Klinikopatolojik özellikler, hastalıksız sağkalım (DFS) ve genel sağkalım (OS) karşılaştırıldı. Sağkalım sonuçları Kaplan–Meier analizi ve log-rank testleri ile değerlendirildi, prognostik faktörler ise Cox orantısal risk regresyonu ile belirlendi. Toplam kohortun 407’sine (%79,5) lenfadenektomi yapılırken, 105’ine (%20,5) yapılmadı. Lenfadenektomi grubunda daha büyük tümör boyutu, yüksek dereceli histoloji, derin miyometriyal invazyon ve LVSI gibi olumsuz patolojik özellikler daha sık izlendi (tümü p<0,01). Ortalama 68 aylık takip sonunda, nüks oranları gruplar arasında benzerdi (%7,9’a karşı %6,7; p=0,837). Beş yıllık DFS oranları lenfadenektomi grubunda %92,5, lenfadenektomi yapılmayan grupta %92,1 idi. Beş yıllık OS oranları ise sırasıyla %83,2 ve %87,5 olarak bulundu. Lenfadenektomi, DFS (HR 1,31; %95 GA 0,58–2,96; p=0,547) veya OS (HR 1,42; %95 GA 0,81–2,47; p=0,199) üzerinde iyileşme ile ilişkili değildi. Çok değişkenli analizde, yaş, tümör derecesi ve LVSI nüks ve sağkalımın bağımsız öngördürücüleri olarak belirlendi; buna karşılık lenfadenektomi bağımsız bir prognostik faktör değildi. Sistematik lenfadenektomi, endometrioid endometriyal kanserde sağkalım avantajı sağlamamaktadır. Onkolojik sonuçların esas belirleyicisi, nodal diseksiyonun kapsamından ziyade tümör biyolojisi gibi görünmektedir.

Keywords

• Endometriyal Kanser
• Genel Sağkalım
• Hastalıksız Sağkalım
• Lenfadenektomi.

The Therapeutic Role and Survival Impact of Systematic Lymphadenectomy in Endometrial Cancer: A Retrospective Cohort Study

Abstract

The aim of this study was to evaluate the therapeutic and prognostic role of systematic lymphadenectomy in patients with endometrioid endometrial cancer. The study included 512 patients with FIGO 2009 stage I-III endometrioid endometrial carcinoma who underwent primary surgical treatment at a tertiary university hospital between January 2010 and May 2025. Patients were categorized according to whether lymphadenectomy was performed. Clinicopathological features, disease-free survival (DFS), and overall survival (OS) were compared. Survival outcomes were estimated using Kaplan–Meier analysis and log-rank tests, and prognostic factors were identified using Cox proportional hazards regression. Of the total cohort, 407 patients (79.5%) underwent lymphadenectomy and 105 (20.5%) did not. The lymphadenectomy group more frequently exhibited adverse pathological features, including larger tumor size, high-grade histology, deep myometrial invasion, and LVSI (all p<0.01). After a median follow-up of 68 months, recurrence rates were comparable between the groups (7.9% vs. 6.7%, p=0.837). The estimated 5-year DFS rates were 92.5% for the lymphadenectomy group and 92.1% for the non-lymphadenectomy group. The 5-year OS rates were 83.2% and 87.5%, respectively. Lymphadenectomy was not associated with improved DFS (HR 1.31, 95% CI 0.58–2.96, p=0.547) or OS (HR 1.42, 95% CI 0.81–2.47, p=0.199). Multivariable analysis identified age, tumor grade, and LVSI as independent predictors of recurrence and survival, whereas lymphadenectomy was not an independent prognostic factor. Systematic lymphadenectomy does not confer a survival benefit in endometrioid endometrial cancer. Tumor biology, rather than the extent of nodal dissection, appears to be the dominant determinant of oncologic outcomes.

Keywords

• Endometrial Cancer
• Overall Survival
• Disease Free Survival
• Lymphadenectomy.

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