Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Gynecol Oncol. 2011 Oct;123(1):65-70. doi: 10.1016/j.ygyno.2011.06.025. Epub 2011 Jul 13.
To validate the Mayo algorithm to intraoperatively identify women with endometrial cancer in whom lymphadenectomy may be safely omitted.
A multi-center retrospective chart review 1977-2010 was completed using two independent institutional endometrial cancer databases. Eligibility criteria were grade 1 or 2 endometrial carcinoma, low-risk histology, and myometrial invasion ≤ 50% on intraoperative pathology consultation; patients were considered to satisfy the Mayo criteria if, in addition to these, tumor diameter on the final pathology report was ≤ 2 cm. Analysis of nodal metastases, recurrent disease, and progression-free survival (PFS) using the Kaplan-Meier method was performed.
Six hundred and two patients met inclusion criteria for the study. Of 110 patients satisfying the Mayo algorithm with an adequate lymphadenectomy, 2 (1.8%) were diagnosed with lymph node metastasis and 4 (3.6%) subsequently developed recurrent disease. The Mayo algorithm identified with a 98.2% negative predictive value women who would not benefit from a lymphadenectomy. There was no significant difference in recurrence rate or PFS between women who underwent lymphadenectomy and those who did not when the Mayo algorithm was satisfied.
The Mayo algorithm intraoperatively identifies tumor characteristics of low-risk disease in endometrial carcinoma that predict a very low likelihood of nodal metastasis and recurrence. Although a small number of patients with advanced stage disease may be missed when applying the Mayo criteria, there is no apparent survival benefit to lymphadenectomy for patients satisfying this algorithm, and these data support its use at other institutions.
验证 Mayo 算法是否可用于术中识别子宫内膜癌患者，这些患者的淋巴结切除术可安全省略。
对 1977 年至 2010 年的两个独立机构子宫内膜癌数据库进行了多中心回顾性图表审查。入选标准为组织学分级为 1 级或 2 级、低危组织学特征、且术中病理会诊显示肌层浸润深度≤50%；如果患者除了满足以上条件，肿瘤的最终病理报告直径≤2cm，则认为其满足 Mayo 标准。使用 Kaplan-Meier 方法对淋巴结转移、复发疾病和无进展生存（PFS）进行分析。
共有 602 例患者符合研究纳入标准。在满足 Mayo 算法且具有足够淋巴结清扫的 110 例患者中，有 2 例（1.8%）被诊断为淋巴结转移，4 例（3.6%）随后发生了复发疾病。Mayo 算法的阴性预测值为 98.2%，可以识别出不会从淋巴结清扫中获益的女性。当满足 Mayo 算法时，行淋巴结清扫与不行淋巴结清扫的女性之间的复发率或 PFS 无显著差异。
Mayo 算法可以在术中识别出子宫内膜癌低危疾病的肿瘤特征，这些特征预示着淋巴结转移和复发的可能性非常低。尽管应用 Mayo 标准时可能会遗漏少数晚期疾病患者，但对于满足该标准的患者，淋巴结清扫并没有明显的生存获益，并且这些数据支持在其他机构使用该标准。
