Minimally invasive surgery versus laparotomy in women with high risk endometrial cancer: A multi-center study performed in Argentina

Objective

Compare the perioperative outcomes and disease-free survival between minimally invasive and open surgery in women with stage I-II high-risk endometrial cancer.

Methods

A retrospective, cohort study was performed involving twenty-four centers from Argentina. Patients with grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 2010-2018 were included. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival.

Results

Of 343 eligible patients, 214 (62 %) underwent open surgery and 129 (38 %) underwent laparoscopic surgery. No significant differences were seen between the two groups with respect to greater or equal grade III Clavien-Dindo postoperative complications (11 % in the open surgery group vs 9 % minimally invasive surgery group; P = 0.34) Minimally invasive surgery was not associated with worse disease-free survival at four years (79.14 % [95 % CI 69.42- 86.08] vs 78.80 % [95 % CI 70.61-84.96]), (p = 0.25), even after creating a Cox proportional model (hazard ratio [HR] 1.08 95 % CI 0.63-1.84); (p = 0.76).

Conclusion

There was no difference between postoperative complications nor oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.

Abstract 362: Patients with cervical cancer display an increase in leukocytes and myeloid cells that express S100A9

Cervical cancer is the second most common type of cancer affecting women worldwide. Leukocytosis have been related with treatment failure in this pathology, associated with the induction and accumulation of myeloid derived suppressor cells (MDSC) in peripheral blood. S100A9 proved to be a useful marker to identify MDSC in whole blood from patients with cancer. In this study, we analyzed the number of leukocytes that express S100A9, dividing them according to monocytic (CD14+) or granulocytic (CD15+) myeloid populations in patients with locally advanced cervical cancer (Ptes) and compared to healthy donors (Crls).

Methods: Peripheral blood samples collected from 11 Crls and 19 Ptes with cervical cancer (stage IB3-IVA) treated in our Institution between 2018 and 2020 with concurrent chemoradiotherapy (cisplatin) followed by brachytherapy. Blood samples (before treatment, before brachytherapy and post-treatment assessment) were obtained. Leukocytes from buffy coat fraction were isolated and stained for S100A9, CD14 and CD15 and then analyzed by flow cytometry. The predictive value of S100A9+ cells between Ptes and Crls was evaluated and associated with therapeutic response.

Results: An increase in leukocytes, granulocytes and monocytes positives for S100A9+ were observed in peripheral blood from Ptes with cervical cancer before treatment compared to Crls. Leukocytes: mean Ptes-Crls: 67.7-48.6; p=0.0017. Granulocytes: mean Ptes-Crls: 62.5-45.9; p=0.0073. Monocytes: median Ptes-Crls: 4.62-2.58; p=0.043. We did not find significant differences in S100A9+ cells over treatment between groups. Tumor response was dichotomized as complete and insufficient response (persistence + progression), relating it to S100A9+ cells. Using a logistic regression model, we observed that the percentage of leukocytes and granulocytes S100A9+ exhibited a trend close to significance of being associated with tumor response [Leukocytes odds ratio (OR): 0.908, 95% confidence interval (CI): 0.819-1.006, p=0.06; Granulocytes OR: 0.907, 95% CI: 0.821-1.002, p=0.057]. In this way, it represents that only a 1% increase in S100A9+ leukocytes or granulocytes are associated with a 9% reduction of having a complete response.

Conclusions: In our study, patients with locally advanced cervical cancer presented an increase in total leukocytes and myeloid cells that express S100A9. The relationship that seems to exist between S100A9+ leukocytes and granulocytes with tumor response may suggest that patients with high levels of these circulating cells could defined a higher risk population associated with therapeutic failure. Further analysis and a larger cohort of patients with cervical cancer will be necessary to assess the potential role of S100A9+ leukocytes and myeloid cells as predictive markers.

Citation Format: Yanina Veronica Langle, Pablo Damian Cresta Morgado, Denise Belgorosky, Pablo Marenco, Pablo Menéndez, Valeria Cáceres, Andrea Aguilar, Marcela Ostojich, Laura Lay, Ana María Eiján, Eduardo Omar Sandes. Patients with cervical cancer display an increase in leukocytes and myeloid cells that express S100A9 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 362.

Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial

BACKGROUND

SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology.

METHODS

Forty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02494063).

RESULTS

We analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases.

INTERPRETATION

SLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases.