Mahdi Haider, Lockhart David, Moselmi-Kebria Mehdi
Division of Gynecologic Oncology, Ob/Gyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Biostatistics, University of Washington, Seattle, WA, USA.
J Gynecol Oncol. 2015 Apr;26(2):134-40. doi: 10.3802/jgo.2015.26.2.134. Epub 2015 Feb 4.
The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC).
Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed.
One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (≥65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p<0.001). The prevalence of nodal metastasis was 24.8%. Out of 724 women who had disease clinically confined to the uterus and underwent lymphadenectomy, 123 (17%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival. Patients who underwent lymphadenectomy were 39% (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.52 to 0.72; p<0.001) less likely to die than patient who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared to patients with 0 nodes removed, patients with more extensive lymphadenectomy (1 to 10 and >10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively.
The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.
本研究旨在评估淋巴结切除术对诊断为子宫透明细胞癌（UCCC）患者生存的影响。
从1988年至2007年的监测、流行病学和最终结果（SEER）项目中识别出诊断为UCCC的患者。仅纳入接受手术治疗的患者。采用学生t检验、Kaplan-Meier生存方法和Cox比例风险回归进行统计分析。
1385例患者符合纳入标准；955例患者（68.9%）接受了淋巴结切除术。与年轻患者相比，老年患者（≥65岁）接受淋巴结切除术的可能性较小（64.3%对75.9%，p<0.001）。淋巴结转移的患病率为24.8%。在724例临床疾病局限于子宫且接受淋巴结切除术的女性中，123例（17%）被发现有淋巴结转移。淋巴结切除术与生存率提高相关。接受淋巴结切除术的患者死亡可能性比未进行该手术的患者低39%（风险比[HR]，0.61；95%置信区间[CI]，0.52至0.72；p<0.001）。此外，更广泛的淋巴结切除术与生存率呈正相关。与切除0个淋巴结的患者相比，接受更广泛淋巴结切除术（切除1至10个及>10个淋巴结）的患者死亡可能性分别低32%（HR，0.68；95%CI，0.56至0.83；p<0.001）和47%（HR，0.53；95%CI，0.43至0.65；p<0.001）。
淋巴结切除术的范围与诊断为UCCC患者的生存率提高相关。
