Chan John K, Wu Huahsi, Cheung Michael K, Shin Jacob Y, Osann Kathryn, Kapp Daniel S
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, University of California, San Francisco Comprehensive Cancer Center, San Francisco, CA 94143, USA.
Gynecol Oncol. 2007 Aug;106(2):282-8. doi: 10.1016/j.ygyno.2007.05.033.
Over two-thirds of patients with endometrioid uterine cancer in the Surveillance, Epidemiology and End Results program from 1988 to 2001 did not undergo a lymphadenectomy. These patients were compared to those who had a lymphadenectomy.
Kaplan-Meier methods and Cox proportional hazards regression analyses were employed.
Of 39,396 women (median age: 65 years) with endometrioid uterine cancers, 12,333 (31.3%) underwent surgical staging procedures including lymphadenectomy. The remainder did not receive a lymphadenectomy. The 5-year disease-specific survival (DSS) of stages I-IV women who underwent lymphadenectomy were 95.5%, 90.4%, 73.8%, and 53.3% compared to 96.6%, 82.2%, 63.1%, and 26.9% in those without lymphadenectomy (p>0.05 for stage I; p<0.001 for stages II-IV). In stage I patients, those who did not receive lymphadenectomy had a higher proportion of tumors with grade 1 histology and/or disease limited to the endometrium compared to those who underwent lymphadenectomy (54.8 % vs. 34.7%; p<0.001, grade 1 disease; 26.6% vs. 15.9%; p<0.001, no myometrial invasion). In patients with stage I grade 3 disease, those who underwent lymphadenectomy had a better 5-year DSS than those without lymphadenectomy (90% vs. 85%; p=0.0001); however, no benefit for lymphadenectomy was seen for patients with stage I grade 1 (p=0.26) and grade 2 (p=0.14) disease. On multivariable analysis, younger age, Caucasian race, early-stage disease, low grade histology, and lymphadenectomy were independent prognostic factors for improved disease-specific survival.
Our data suggest that lymphadenectomy is associated with an improved survival in stage I grade 3 and more advanced endometrioid uterine cancers.
在1988年至2001年的监测、流行病学和最终结果计划中，超过三分之二的子宫内膜样子宫癌患者未接受淋巴结切除术。将这些患者与接受淋巴结切除术的患者进行比较。
采用Kaplan-Meier方法和Cox比例风险回归分析。
在39396例（中位年龄：65岁）子宫内膜样子宫癌女性中，12333例（31.3%）接受了包括淋巴结切除术在内的手术分期程序。其余患者未接受淋巴结切除术。接受淋巴结切除术的I-IV期女性的5年疾病特异性生存率（DSS）分别为95.5%、90.4%、73.8%和53.3%，而未接受淋巴结切除术的患者分别为96.6%、82.2%、63.1%和26.9%（I期p>0.05；II-IV期p<0.001）。在I期患者中，未接受淋巴结切除术的患者与接受淋巴结切除术的患者相比，组织学1级和/或疾病局限于子宫内膜的肿瘤比例更高（54.8%对34.7%；p<0.001，1级疾病；26.6%对15.9%；p<0.001，无肌层浸润）。在I期3级疾病患者中，接受淋巴结切除术的患者5年DSS优于未接受淋巴结切除术的患者（90%对85%；p=0.0001）；然而，对于I期1级（p=0.26）和2级（p=0.14）疾病患者，未观察到淋巴结切除术的益处。多变量分析显示，年龄较小、白种人、早期疾病、低级别组织学和淋巴结切除术是改善疾病特异性生存的独立预后因素。
我们的数据表明，淋巴结切除术与I期3级及更晚期子宫内膜样子宫癌患者生存率的提高相关。
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