Department of Gynaecology, Metaxa Memorial Cancer Hospital, Botassi 51, Piraeus, Greece.
Arch Gynecol Obstet. 2010 Dec;282(6):659-64. doi: 10.1007/s00404-010-1649-0. Epub 2010 Aug 19.
Uterine carcinosarcomas are rare and highly aggressive tumours. Although surgery is the cornerstone of treatment, the extent of the procedure remains controversial. We sought to evaluate the available literature data regarding the rationale of lymphadenectomy and its possible impact on survival.
A systematic Medline, PubMed and Scopus search with special focus on the publications of the last decade.
Carcinosarcomas have similar clinical characteristics and behaviour with grade 3 endometrioid or aggressive variants of uterine adenocarcinoma. All studies have demonstrated that the FIGO stage of disease is the most important prognostic factor, followed by the depth of myometrial invasion, extra-uterine spread and positive peritoneal cytology. Moreover, lymph node involvement will be found in 14-38% of patients undergoing lymphadenectomy. This figure is similar to the one reported for endometrial carcinoma. Therefore, lymphadenectomy is mandatory for staging purposes. Regarding its impact on survival, the majority of studies confirm a significant survival benefit. The possible mechanisms for the improvement of survival from lymphadenectomy include removal of micro-metastatic foci, reduction of recurrence risk (removal of "target tissue") and mechanical circumvallate of the disease. Given that 5-38% of the patients will experience local recurrence and 30-83% distant metastases, lymphadenectomy reduces the risk of the first and identifies patients in advanced stage that may benefit from adjuvant chemotherapy, aiming to reduce the second and ultimately improve overall survival.
Our review data fully justifies the rationale of lymphadenectomy, which beyond staging information seems to offer a measurable survival benefit.
子宫癌肉瘤是一种罕见且高度侵袭性的肿瘤。尽管手术是治疗的基石，但手术的范围仍存在争议。我们旨在评估关于淋巴结切除术的合理性及其对生存可能产生的影响的现有文献数据。
系统地在 Medline、PubMed 和 Scopus 上进行搜索，特别关注过去十年的出版物。
癌肉瘤具有与高级别子宫内膜样腺癌或侵袭性变体相似的临床特征和行为。所有研究均表明，疾病的 FIGO 分期是最重要的预后因素，其次是肌层浸润深度、子宫外扩散和阳性腹膜细胞学。此外，在接受淋巴结切除术的患者中，将发现 14-38%的患者存在淋巴结受累。这一数字与子宫内膜癌报告的数字相似。因此，淋巴结切除术是分期的必要手段。关于其对生存的影响，大多数研究证实存在显著的生存获益。淋巴结切除术改善生存的可能机制包括去除微转移灶、降低复发风险（去除“靶组织”）和机械包围疾病。鉴于 5-38%的患者会经历局部复发和 30-83%的远处转移，淋巴结切除术降低了首次发生的风险，并确定了处于晚期可能受益于辅助化疗的患者，旨在降低第二次风险并最终改善总体生存。
我们的综述数据充分证明了淋巴结切除术的合理性，除了分期信息外，它似乎还提供了可衡量的生存获益。
