Use of sentinel LYMPH node and molecular classification in selection of adjuvan treatment in endometrium cancer

Aim: This study aims to evaluate the effect of sentinel lymph node positivity and gene mapping on the determination of the current treatment plan in endometrial cancer. Patients and method: A total of 100 patients with primary tissue diagnosis of endometrial cancer who underwent sentinel lymph node procedure during surgery in our Gynecology and Obstetrics Clinic in the Faculty of Medicine at Ondokuz Mayıs University between the dates of October 2020 and October 2022 were included in the study. The sentinel lymph node procedure was conducted with methylene blue and indocyanine green (ICG). The clinical and pathology data belonging to the patients included in our retrospective and monocentric study were evaluated along with the genetic mutation results attained as a result of the immunohistochemical staining performed on data from the medical pathology section of the operation material. The collected data were analyzed through SPSS 28.0.1. Findings: Bilateral staining was observed in 63.6%(n=63) of the patients. The histology types of 87%(n=87) of the patients were determined as endometrioid. It was observed that the myometrial invasion rates were invasive up to 1/2 of the myometrium in 56%(n=28) of the patients, LVSI was present in 33%(n=32), Stage IA was determined in 71.9%(n=69), POLE mutation was present in 1%(n=1), and exitus status was determined in 2%(n=2). It was also observed that lymph nodes of 93%(n=93) of the patients were non-metastatic sentinel, 3%(n=3) were micro-metastatic, 2%(n=2) were isolated tumor cells, and 2%(n=2) were macro-metastatic. The p53 mutation was also found in 14 patients. 35.7%(n=5) of these were endometrioid; 28.6%(n=4) were serous; 21.4%(n=3) were carcinosarcoma, and 14.3%(n=2) were mixed-type. None of the ITC and macro-metastatic involvement groups had p53 mutation while 33.3%(n=1) of the micro-metastatic group and 14.1%(n=13) of the non-metastatic sentinel group had it. There is no difference between the average recurrence-free survival times in terms of the p53 mutation positivity (p=0.174). The recurrence-free survival time was determined as 26.612 months in non-positive ones while 23.1 months were determined in positive ones. 28 patients with MMR mutations were also identified. 92.8%(n=52) of these were determined as endometrioid-type. There is no difference between the average total survival times in terms of the MMR mutation (p=0.713). The average survival time for those without MMR loss was 26.472 months while it was determined as 24.167 months in those experiencing MMR loss. POLE mutation was present in 1.1%(n=1) of the non-metastatic sentinel group. In our study, there were 64 patients who did not receive adjuvant therapy. 35 (35%) patients received adjuvant therapy. 1 patient could not be followed up. Among the adjuvant treatments, 11 (31.4%) patients received chemotherapy alone, 18 (51.4%) patients received only RT, while 6 (17.1%) patients received both CT and EBRT. 5 (35.7%) of 14 patients with positive P53 mutation were endometrioid type. While 1 out of 5 patients with endometrioid type did not receive adjuvant treatment, 2 of the patients received vaginal brachytherapy and the other 2 patients received only KT. Conclusion: In conclusion, it is anticipated that adjuvant treatment planning is going to be developed by evaluating the molecular subgroups together besides the advancing sentinel lymph node procedures in endometrial cancer treatment in the forthcoming years.