Efficacy of SLNB in early endometrial adenocarcinoma in China: a retrospective cohort study based on inverse probability of treatment weighting

Endometrial cancer significantly impacts women’s reproductive health and quality of life, with lymph node metastasis serving as a crucial prognostic factor. Given the low metastasis rate, not all early-stage patients require lymph node dissection. The NCCN upgraded Sentinel Lymph Node Biopsy (SLNB) technology to Class 2A evidence. However, the applicability of SLNB for Chinese patients remains uncertain. This study evaluates the efficacy and safety of SLNB in a Chinese population. A retrospective cohort study was conducted at Guangdong Provincial Hospital of Chinese Medicine from August 2019 to December 2022, involving 166 early-stage endometrial adenocarcinoma patients. Of these, 137 patients were assessed as moderate to high-differentiated endometrioid adenocarcinoma. Patients were divided into Sentinel Lymph Node Biopsy (SLNB, N = 43) and systematic lymph node dissection (SLND, N = 94) groups, with a median follow-up time of 39 (24, 55) months. Primary outcomes were postoperative disease progression-free survival and one-month complication rates, with secondary endpoints including surgical parameters and quality of life indicators. During the follow-up(median follow-up time 39 months), 1 recurrence occurred in the SLNB group, with no recurrences in the SLND group. Sentinel Lymph Node Biopsy (SLNB) showed no statistically significant differences compared with traditional Sentinel Lymph Node Dissection (SLND) in oncological assessment, with no significant variations in postoperative pathological staging (β = 0.80, 95%CI: -1.29 to 2.90, p = 0.455), pathological grading (β = -0.115, 95%CI: -0.99 to 0.76, p = 0.800), and additional treatment evaluation (β = -0.214, 95%CI: -1.52 to 1.09, p = 0.749), with one recurrence in the SLNB group during follow-up. SLNB significantly improved surgical indicators: operation time reduced by 85.13 min (p < 0.001), blood loss decreased by 44.82 ml (p < 0.001), hospital stay shortened by 1.19 days (p = 0.030), with significantly lower postoperative day 1 pain scores. At 6 h post-surgery, both groups showed significant BADL decline (β = -21.53, 95%CI: -25.7 to -17.4, p < 0.001), with less functional impairment in the SLNB group and significantly shorter urinary catheter placement time (β = + 1.24, 95%CI: 0.90 to 1.59, p < 0.001). Complication analysis revealed significantly higher rates of lymphatic reflux obstruction (β = 18.22, 95%CI: 17.38 to 19.05, p < 0.001) and intestinal obstruction (β = 18.17, 95%CI: 16.16 to 20.17, p < 0.001) in the SLND group, suggesting a marked advantage of SLNB in complication management. For early-stage endometrial cancer patients with moderate to high differentiation and lesions confined to the inner half of the myometrium, SLNB demonstrates safety and efficacy as a minimally invasive alternative, significantly improving surgical outcomes and patient prognosis.