Maintained survival outcome after reducing lymphadenectomy rates and optimizing adjuvant treatment in endometrial cancer

D Forsse, H F Berg, O Bozickovic, H Engerud, M K Halle, E A Hoivik, K Woie, H M J Werner, I S Haldorsen, J Trovik, C Krakstad*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: Main controversies in endometrial cancer treatment include the role of lymphadenectomy and optimal adjuvant treatment. We assessed clinical outcome in a population-based endometrial cancer cohort in relation to changes in treatment management over two decades.

METHODS: All consenting endometrial cancer patients receiving primary treatment at Haukeland University Hospital from 2001 to 2019 were included (n = 1308). Clinicopathological variables were evaluated for year-to-year changes. Clinical outcome before and after discontinuing adjuvant radiotherapy and individualizing extent of lymphadenectomy was analyzed.

RESULTS: The rate of lymphadenectomy was reduced from 78% in 2001-2012 to 53% in 2013-2019. The rate of patients with verified lymph node metastases was maintained (9% vs 8%, p = 0.58) and FIGO stage I patients who did not undergo lymphadenectomy had stable 3-year recurrence-free survival (88% vs 90%, p = 0.67). Adjuvant chemotherapy for completely resected FIGO stage III patients increased from 27% to 97% from 2001 to 2009 to 2010-2019, while adjuvant radiotherapy declined from 57% to 0% (p < 0.001). These patients had improved 5-year overall- and recurrence-free survival; 0.49 [95% CI: 0.37-0.65] in 2001-2009 compared to 0.61 [0.45-0.83] in 2010-2019, p = 0.04 and 0.51 [0.39-0.68] to 0.71 [0.60-0.85], p = 0.03, respectively. For stage I, II and IV, survival rates were unchanged.

CONCLUSIONS: Our study demonstrates that preoperative stratification by imaging and histological assessments permits a reduction in lymphadenectomy to around 50%, and is achievable without an increase in recurrences at 3 years. In addition, our findings support that adjuvant chemotherapy alone performs equally to adjuvant radiotherapy with regard to survival, and is likely superior in advanced stage patients.

Original languageEnglish
Pages (from-to)396-404
Number of pages9
JournalGynecologic Oncology
Issue number2
Publication statusPublished - Feb 2021


  • Aged
  • Aged, 80 and over
  • Chemoradiotherapy, Adjuvant/standards
  • Chemotherapy, Adjuvant/standards
  • Disease-Free Survival
  • Endometrial Neoplasms/diagnosis
  • Endometrium/diagnostic imaging
  • Female
  • Fluorodeoxyglucose F18/administration & dosage
  • Follow-Up Studies
  • Humans
  • Hysterectomy
  • Lymph Node Excision/standards
  • Lymphatic Metastasis/diagnosis
  • Magnetic Resonance Imaging/standards
  • Middle Aged
  • Neoplasm Recurrence, Local/epidemiology
  • Neoplasm Staging
  • Positron Emission Tomography Computed Tomography/standards
  • Practice Guidelines as Topic
  • Preoperative Care/methods
  • Radiotherapy, Adjuvant/standards
  • Risk Assessment/methods
  • Endometrial cancer
  • Lymphadenectomy
  • Radiotherapy
  • Survival
  • Chemotherapy


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