Division of Gynaecologic Oncology, National Hospital Organization, Hokkaido Cancer Centre, Sapporo, Japan.
Lancet. 2010 Apr 3;375(9721):1165-72. doi: 10.1016/S0140-6736(09)62002-X. Epub 2010 Feb 24.
In response to findings that pelvic lymphadenectomy does not have any therapeutic benefit for endometrial cancer, we aimed to establish whether complete, systematic lymphadenectomy, including the para-aortic lymph nodes, should be part of surgical therapy for patients at intermediate and high risk of recurrence.
We selected 671 patients with endometrial carcinoma who had been treated with complete, systematic pelvic lymphadenectomy (n=325 patients) or combined pelvic and para-aortic lymphadenectomy (n=346) at two tertiary centres in Japan (January, 1986-June, 2004). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy or chemotherapy. The primary outcome measure was overall survival.
Overall survival was significantly longer in the pelvic and para-aortic lymphadenectomy group than in the pelvic lymphadenectomy group (HR 0.53, 95% CI 0.38-0.76; p=0.0005). This association was also recorded in 407 patients at intermediate or high risk (p=0.0009), but overall survival was not related to lymphadenectomy type in low-risk patients. Multivariate analysis of prognostic factors showed that in patients with intermediate or high risk of recurrence, pelvic and para-aortic lymphadenectomy reduced the risk of death compared with pelvic lymphadenectomy (0.44, 0.30-0.64; p<0.0001). Analysis of 328 patients with intermediate or high risk who were treated with adjuvant radiotherapy or chemotherapy showed that patient survival improved with pelvic and para-aortic lymphadenectomy (0.48, 0.29-0.83; p=0.0049) and with adjuvant chemotherapy (0.59, 0.37-1.00; p=0.0465) independently of one another.
Combined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence. If a prospective randomised or comparative cohort study is planned to validate the therapeutic effect of lymphadenectomy, it should include both pelvic and para-aortic lymphadenectomy in patients of intermediate or high risk of recurrence.
Japanese Foundation for Multidisciplinary Treatment of Cancer, and the Japan Society for the Promotion of Science.
针对盆腔淋巴结清扫术对子宫内膜癌没有治疗益处的发现，我们旨在确定对于复发风险处于中高危的患者，是否应该将完整的、系统性的淋巴结清扫术（包括腹主动脉旁淋巴结）作为手术治疗的一部分。
我们在日本的两个三级中心（1986 年 1 月至 2004 年 6 月）选择了 671 名接受完整的、系统性的盆腔淋巴结清扫术（n=325 名患者）或联合盆腔和腹主动脉旁淋巴结清扫术（n=346 名患者）治疗的子宫内膜癌患者。有复发中高危风险的患者接受辅助放疗或化疗。主要观察指标是总生存。
与盆腔淋巴结清扫术组相比，盆腔和腹主动脉旁淋巴结清扫术组的总生存时间明显更长（HR 0.53，95%CI 0.38-0.76；p=0.0005）。在 407 名中高危患者中也观察到了这种关联（p=0.0009），但在低危患者中，总生存与淋巴结清扫术类型无关。对复发中高危患者的多因素预后因素分析显示，与盆腔淋巴结清扫术相比，盆腔和腹主动脉旁淋巴结清扫术降低了死亡风险（0.44，0.30-0.64；p<0.0001）。对接受辅助放疗或化疗的 328 名中高危患者的分析表明，与盆腔淋巴结清扫术相比，盆腔和腹主动脉旁淋巴结清扫术（0.48，0.29-0.83；p=0.0049）和辅助化疗（0.59，0.37-1.00；p=0.0465）均可改善患者生存。
建议对复发中高危的子宫内膜癌患者行盆腔和腹主动脉旁淋巴结清扫术。如果计划进行前瞻性随机或对照队列研究以验证淋巴结清扫术的治疗效果，则应将其纳入复发中高危风险的患者中进行盆腔和腹主动脉旁淋巴结清扫术。
日本癌症综合治疗基金会和日本癌症促进学会。
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