淋巴结切除术在子宫内膜样癌中的影响。

Impact of lymphadenectomy in uterine endometrioid carcinoma.

机构信息

Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.

出版信息

Eur J Surg Oncol. 2013 Apr;39(4):350-7. doi: 10.1016/j.ejso.2013.01.002. Epub 2013 Feb 23.

DOI:10.1016/j.ejso.2013.01.002

PMID:23462243

Abstract

AIMS

To investigate the role of lymphadenectomy in uterine endometrioid carcinoma based on the 2009 FIGO staging system.

METHODS

Using an institution-maintained cancer registry database, all patients who were treated surgically for endometrial cancer from 1991 to 2008 in two medical centers were analyzed. Kaplan-Meier and Cox proportional hazards methods were used to determine the role of lymphadenectomy.

RESULTS

From 961 women with uterine endometrioid carcinoma, 680 underwent lymphadenectomy and 281 did not. Young age, early-stage disease, low-grade tumor, and lymphadenectomy were favorable independent prognostic factors. The five-year disease-specific survival (DSS) of stages IA, IB, II, and III, and the two-year DSS of stage IV patients who underwent lymphadenectomy were 97.8%, 88.3%, 91.5%, 70.5%, and 32.1%, respectively, compared to 98.7%, 70.0%, 73.3%, 42.9%, and 16.6% in those without lymphadenectomy (p > 0.05 for stage IA; p < 0.01 for stages IB-IV, log-rank test). In high-risk patients (i.e., poorly-differentiated, outer-half myometrial invasion, and stages II-IV), more extensive lymph node resection was associated with an improved five-year DSS, from 71.3% (1-10 nodes removed) and 85.3% (11-20 nodes removed) to 86.8% (>20 nodes removed) (p = 0.02, log-rank test). For stage IIIC-IV patients with nodal metastasis, the extent of node resection also significantly improved the five-year DSS, from 34.4% (1-10 nodes removed) and 62.4% (11-20 nodes removed) to 79.6% (>20 nodes removed) (p = 0.04, log-rank test).

CONCLUSIONS

Lymphadenectomy improves the survival of patients with uterine endometrioid carcinoma stage IB to stage IV. The extent of lymphadenectomy also improves the survival of high-risk patients and those with nodal disease.

摘要

目的

基于 2009 年 FIGO 分期系统，探讨淋巴结切除术在子宫子宫内膜样癌中的作用。

方法

使用机构维护的癌症登记数据库，分析了 1991 年至 2008 年在两个医疗中心接受手术治疗的子宫内膜癌患者。使用 Kaplan-Meier 和 Cox 比例风险方法来确定淋巴结切除术的作用。

结果

在 961 名患有子宫子宫内膜样癌的女性中，680 名接受了淋巴结切除术，281 名未接受。年轻、早期疾病、低级别肿瘤和淋巴结切除术是有利的独立预后因素。行淋巴结切除术的 IA、IB、II 和 III 期患者的 5 年疾病特异性生存率（DSS）分别为 97.8%、88.3%、91.5%、70.5%和 32.1%，而未行淋巴结切除术的患者分别为 98.7%、70.0%、73.3%、42.9%和 16.6%（IA 期的 p>0.05；IB-IV 期的 p<0.01，对数秩检验）。在高危患者（即分化差、外 1/2 肌层浸润和 II-IV 期）中，更广泛的淋巴结切除与改善的 5 年 DSS 相关，从 71.3%（1-10 个淋巴结切除）和 85.3%（11-20 个淋巴结切除）提高到 86.8%（>20 个淋巴结切除）（p=0.02，对数秩检验）。对于有淋巴结转移的 IIIC-IV 期患者，淋巴结切除范围也显著改善了 5 年 DSS，从 34.4%（1-10 个淋巴结切除）和 62.4%（11-20 个淋巴结切除）提高到 79.6%（>20 个淋巴结切除）（p=0.04，对数秩检验）。