Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Gynecol Oncol. 2012 Oct;127(1):5-10. doi: 10.1016/j.ygyno.2012.06.035. Epub 2012 Jul 3.
Since 1999, patients with low risk endometrial cancer (EC) as defined by the Mayo criteria have preferably not undergone lymphadenectomy (LND) at our institution. Here we prospectively assess survival, sites of recurrence, morbidity, and cost in this low risk cohort.
Cause-specific survival (CSS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Complications were graded per the Accordion Classification. Thirty-day cost analyses were expressed in 2010 Medicare dollars.
Among 1393 consecutive surgically managed cases, 385 (27.6%) met inclusion criteria, accounting for 34.1% of type I EC. There were 80 LND and 305 non-LND cases. Complications in the first 30 days were significantly more common in the LND cohort (37.5% vs. 19.3%; P<0.001). The prevalence of lymph node metastasis was 0.3% (1/385). Over a median follow-up of 5.4 years only 5 of 31 deaths were due to disease. The 5-year CSS in LND and non-LND cases was 97.3% and 99.0%, respectively (P=0.32). None of the 11 total recurrences occurred in the pelvic or para-aortic nodal areas. Median 30-day cost of care was $15,678 for LND cases compared to $11,028 for non-LND cases (P<0.001). The estimated cost per up-staged low-risk case was $327,866 to $439,990, adding an additional $1,418,189 if all 305 non-LND cases had undergone LND.
Lymphadenectomy dramatically increases morbidity and cost of care without discernible benefits in low-risk EC as defined by the Mayo criteria. In these low-risk patients, hysterectomy with salpingo-oophorectomy alone is appropriate surgical management and should be standard of care.
自 1999 年以来，我们医院的低危子宫内膜癌（EC）患者（根据 Mayo 标准定义）优选不进行淋巴结切除术（LND）。在此，我们前瞻性评估该低危患者队列的生存情况、复发部位、发病率和成本。
使用 Kaplan-Meier 法估计特定原因生存率（CSS），并使用对数秩检验进行比较。并发症按 Accordion 分类分级。30 天的成本分析以 2010 年医疗保险美元表示。
在连续 1393 例手术治疗的病例中，385 例（27.6%）符合纳入标准，占 I 型 EC 的 34.1%。其中有 80 例行 LND，305 例行非 LND。在 LND 组中，术后 30 天的并发症发生率明显更高（37.5%比 19.3%；P<0.001）。淋巴结转移的发生率为 0.3%（1/385）。中位随访 5.4 年后，仅有 31 例死亡中的 5 例归因于疾病。LND 和非 LND 病例的 5 年 CSS 分别为 97.3%和 99.0%（P=0.32）。在所有 11 例总复发病例中，均未发生盆腔或腹主动脉淋巴结区域的复发。LND 病例的中位 30 天医疗费用为 15678 美元，而非 LND 病例为 11028 美元（P<0.001）。如果对所有 305 例非 LND 病例进行 LND，则对每例升期低危病例的估计成本为 327866 美元至 439990 美元，增加 1418189 美元。
根据 Mayo 标准定义的低危 EC，LND 显著增加了发病率和医疗费用，但未带来明显的获益。在这些低危患者中，单纯子宫切除术加输卵管卵巢切除术是合适的手术治疗方法，应作为标准治疗方法。
