Intermediate-high risk group
The pathological inclusion criteria used by Benedetti et
al.(34) were FIGO 1988 Stage IB and G1, satisfying
current intermediate and high-intermediate risk groups. They reported
that pelvic LND did not improve 5-year DFS or OS. Para-aortic LND and
the use of adjuvant therapies was left to the discretion of the
clinician, both of which may have influenced metastasis and therefore
survival. A recent matched-pair study that focussed specifically on
intermediate risk patients supported the findings of Benedetti et al.
with the addition that post-operative morbidity was similar in both
groups(30). Although a risk stratification system
similar to ESMO-ESGO-ESTRO 2016 was adopted, cervical involvement was
considered as an additional defining feature(35).
Before ESMO-ESGO-ESTRO 2016, multiple studies like the previously
discussed ASTEC 2009, combined both intermediate and high-risk
groups(20,36). We have followed suit for the purposes
of standardisation. The ASTEC trial showed no benefit of pelvic LND in
terms of RFS and OS. Alternatively, surgical staging including LND
demonstrated improved survival in a large patient cohort with
intermediate-high risk EC(36). This study was limited
by its retrospective nature and therefore could not account for
confounding factors such as comorbidities. Similar findings were
observed in a retrospective multicentre study with the new
ESMO-ESGO-ESTRO 2016 high-intermediate risk group(37).