Objective: To assess overall survival (OS) for patients undergoing surgical staging with sentinel lymph node dissection (SLND) in patients with high risk uterine serous carcinoma (USC).
Methods: Patients diagnosed with USC that underwent surgical staging with SLND from the years 2018-2022 were included for analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) national database. Patients were stratified by pathologic lymph node (LN) assessment into true SLND group (1-2 pelvic LN retrieved) and false SLND group (> 2 pelvic LN retrived). Patients with 0 LN retrieved were excluded from the data. OS was recorded in months from time of primary treatment to death or loss to follow up. Chi-square analysis and ANOVA was used to evaluate the data set for impact of lymph node count OS between the two categorical groups; true and false SLND.
Results: A total of 524 patients met inclusion criteria. Patients ranged from ages 35-85+ with a median age range of 70-74. Racial/ethnic distribution included 55.3% Non-Hispanic White, 21% Non-Hispanic Black, 11.5% Hispanic, 11.6% Asian/Pacific Islander, and 0.6% American Indian/Alaska Native. Of the patients included in the study, 34.5% (n=175) met true SLND group stratification and 65.5% (n=343) were in the false SLND group. Staging descriptives are as follows; 69.6% stage 1, 5.3% stage 2, 18.7% stage 3, 5.8% stage 4, and 0.6% were unknown at time of diagnosis. Of these, 57.8% of patients underwent adjuvant radation (RT) with no patients in either group receiving neoadjuvant RT. Negative peritoneal washings were found in 56.9% of patients, positive washings in 11.1% , and suspicious or atypical washings in 5.0%. A total of 143 pts (27.2%) had additional sampling of the para-aortic lymph nodes (PALN), with greater PALN assessment in the false SLND group (p
Conclusion: SLND has become a widely adopted staging technique in recent years, and has repeatedly shown good diagnostic value for both low and high risk populations. However, its prognostic significance and impact on long-term OS in high risk patients including USC warrants continued investigation. This study highlights the variability of pathologic lymph node count return in patients undergoing presumed SLND. Additionally, we found no statistical association between higher pathologic LN assessment and OS. Our results further emphasize that SLND remains a valuable diagnostic and prognostic tool for patients with high risk USC.