Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2013 Sep;130(3):441-5. doi: 10.1016/j.ygyno.2013.05.035. Epub 2013 Jun 5.
Paraaortic lymph node (PA) dissemination in endometrial cancer (EC) is uncommon and a systematic infrarenal PA dissection carries morbidity. Our objective was to identify a subgroup of EC patients who may potentially forego PA lymphadenectomy (LND).
The study endpoint (PA Metastasis or Recurrence; PAMR) was defined as detection of metastasis to PA nodes (among those with any type of PA LND) or PA recurrence within 2 years (among patients without PA LND or those with negative nodes in the context of an inadequate (<5 nodes) PA LND). Patients with non-endometrioid histology, stage IV disease, synchronous cancers, gross extrauterine or gross adnexal disease, neoadjuvant therapy, or insufficient follow-up were excluded. Multivariable logistic regression analysis identified predictors of PAMR.
Of the 946 patients, PAMR was observed in 4% (36/946). Multivariable analysis identified positive pelvic nodes (odds ratio (OR) 24.2; p<0.001), >50% MI (OR 5.3; p<0.001) and lymphovascular space invasion (LVSI) (OR 3.7; p=0.005) as the only three independent predictors of PAMR. When all three factors were absent (77% of study cohort), the predicted probability of PAMR was 0.6%. If intraoperative frozen section is not available on pelvic lymph nodes and LVSI, omitting PA LND in all patients with ≤ 50% MI would affect 84% (792/946) of the total cohort, with a 1.1% risk of PAMR (9/792).
The majority of patients with endometrioid EC may potentially forgo PA LND with expected reductions in surgical morbidity and cost. This cohort may be identified by a combined absence of: positive pelvic nodes, >50% MI and LVSI.
在子宫内膜癌（EC）中，腹主动脉旁淋巴结（PA）的转移并不常见，系统的肾下 PA 解剖术会带来发病率。我们的目的是确定一组可能可以避免 PA 淋巴结清扫术（LND）的 EC 患者。
本研究的终点（PA 转移或复发；PAMR）定义为检测到 PA 淋巴结转移（在任何类型的 PA LND 中）或 2 年内 PA 复发（在没有 PA LND 的患者中，或在 PA LND 中没有检测到淋巴结且淋巴结数量不足（<5 个）的患者中）。排除非子宫内膜样组织学、IV 期疾病、同步癌症、明显的子宫外或附件疾病、新辅助治疗或随访不足的患者。多变量逻辑回归分析确定了 PAMR 的预测因素。
在 946 例患者中，观察到 PAMR 占 4%（36/946）。多变量分析确定了阳性盆腔淋巴结（比值比（OR）24.2；p<0.001）、>50% MI（OR 5.3；p<0.001）和淋巴血管间隙浸润（LVSI）（OR 3.7；p=0.005）是 PAMR 的唯一三个独立预测因素。当所有三个因素均不存在（研究队列的 77%）时，PAMR 的预测概率为 0.6%。如果盆腔淋巴结和 LVSI 术中无法进行冰冻切片检查，则对于 MI≤50%的所有患者，如果省略 PA LND，则将影响总队列的 84%（946/792），PAMR 的风险为 1.1%（9/792）。
大多数子宫内膜样 EC 患者可能可以避免 PA LND，预期手术发病率和成本会降低。通过同时不存在以下情况，可识别出该队列：阳性盆腔淋巴结、>50% MI 和 LVSI。
