Cragun Janiel M, Havrilesky Laura J, Calingaert Brian, Synan Ingrid, Secord Angeles Alvarez, Soper John T, Clarke-Pearson Daniel L, Berchuck Andrew
Duke University Medical Center, Box 3079, Durham, NC 27710, USA.
J Clin Oncol. 2005 Jun 1;23(16):3668-75. doi: 10.1200/JCO.2005.04.144. Epub 2005 Feb 28.
Selective lymphadenectomy is widely accepted in the management of endometrial cancer. Purported benefits are individualization of adjuvant therapy based on extent of disease and resection of occult metastases. Our goal was to assess effects of the extent of selective lymphadenectomy on outcomes in women with apparent stage I endometrial cancer at laparotomy.
Patients with endometrial cancer who received primary surgical treatment between 1973 and 2002 were identified through an institutional tumor registry. Inclusion criteria were clinical stage I/IIA disease and procedure including hysterectomy and selective lymphadenectomy (pelvic or pelvic + aortic). Exclusion criteria included presurgical radiation, grossly positive lymph nodes, or extrauterine metastases at laparotomy. Recurrence and survival were analyzed using Kaplan-Meier analysis and Cox proportional hazards model.
Among 509 patients, the median number of lymph nodes removed was 15 (median pelvic, 11; median aortic, three). Pelvic and aortic node metastases were found in 24 (5%) of 509 patients and 11 (3%) of 373 patients, respectively. Patients with poorly differentiated cancers having more than 11 pelvic nodes removed had improved overall survival (hazard ratio [HR], 0.25; P < .0001) and progression-free survival (HR, 0.26; P < .0001) compared with patients having poorly differentiated cancers with 11 or fewer nodes removed. Number of nodes removed was not predictive of survival among patients with cancers of grade 1 to 2. Performance of aortic selective lymphadenectomy was not associated with survival. Three (27%) of 11 patients with microscopic aortic nodal metastasis are alive without recurrence.
These data add to the literature documenting the possible therapeutic benefit of selective lymphadenectomy in management of patients with apparent early-stage endometrial cancer.
选择性淋巴结切除术在子宫内膜癌的治疗中被广泛接受。其所谓的益处在于根据疾病范围个体化辅助治疗以及切除隐匿性转移灶。我们的目标是评估选择性淋巴结切除术范围对开腹手术时看似为Ⅰ期子宫内膜癌女性患者预后的影响。
通过机构肿瘤登记处识别出1973年至2002年间接受原发性手术治疗的子宫内膜癌患者。纳入标准为临床Ⅰ/ⅡA期疾病以及包括子宫切除术和选择性淋巴结切除术（盆腔或盆腔+主动脉旁）的手术。排除标准包括术前放疗、术中淋巴结明显阳性或存在子宫外转移。采用Kaplan-Meier分析和Cox比例风险模型分析复发和生存情况。
509例患者中，切除淋巴结的中位数为15个（盆腔淋巴结中位数为11个；主动脉旁淋巴结中位数为3个）。509例患者中有24例（5%）发现盆腔淋巴结转移，373例患者中有11例（3%）发现主动脉旁淋巴结转移。与切除11个或更少盆腔淋巴结的低分化癌患者相比，切除超过11个盆腔淋巴结的低分化癌患者总生存期（风险比[HR]，0.25；P<.0001）和无进展生存期（HR，0.26；P<.0001）得到改善。切除淋巴结的数量对1至2级癌症患者生存率无预测价值。主动脉旁选择性淋巴结切除术的实施与生存率无关。11例镜下主动脉旁淋巴结转移患者中有3例（27%）存活且无复发。
这些数据补充了文献，证明选择性淋巴结切除术在看似早期子宫内膜癌患者治疗中可能具有治疗益处。
