淋巴结清扫术能否提高子宫平滑肌肉瘤患者的生存率？

Does Lymphadenectomy Improve Survival in Uterine Leiomyosarcoma?

作者信息

Tasci Tolga, Karalok Alper, Taskin Salih, Ureyen Isin, Kımyon Gunsu, Tulek Firat, Ozfuttu Ahmet, Turan Taner, Tulunay Gokhan, Kose M Faruk, Ortac Firat

机构信息

*Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey; and †Department of Gynecologic Oncology, Ankara University School of Medicine, Ankara, Turkey; and ‡Department of Pathology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

出版信息

Int J Gynecol Cancer. 2015 Jul;25(6):1031-6. doi: 10.1097/IGC.0000000000000452.

DOI:10.1097/IGC.0000000000000452

PMID:25853382

Abstract

INTRODUCTION

The role of lymphadenectomy in the management of uterine leiomyosarcoma (LMS) is controversial. We aimed to identify whether lymph node dissection (LND) has any survival benefit in uterine LMS.

METHODS

Data of 95 patients with histologically proven uterine LMS from 2 tertiary centers (1993 through 2009) were retrospectively analyzed. Kaplan-Meier and Cox proportional hazards regression models were used for analyses.

RESULTS

Mean age was 51.5 years. Thirty-six (37.9%) underwent LND. The median lymph node count was 54. Eight (22.2%) patients had lymphatic metastasis. Median follow-up was 26 months. Sixty-two (65%) patients had recurrence and 48 (50.5%) died. Median disease-free survival (DFS) was 19 months for both group of patients who had or did not have LND, and median overall survival (OS) was 29 and 26 months, respectively (P = 0.4). Five-year DFS was 35.9% vs 26.8% (P = 0.4), and 5-year OS was 45.4% vs 43.8% (P = 0.22) for the groups. Multivariate analyses did not reveal a single independent prognostic factor in respect to DFS or OS.

CONCLUSION

Higher rate of lymph node metastasis in patients with extrauterine disease indicated the importance of LND in LMS. However, the survival benefit of lymphadenectomy could not be shown.

摘要

引言

淋巴结清扫术在子宫平滑肌肉瘤（LMS）治疗中的作用存在争议。我们旨在确定淋巴结清扫术（LND）对子宫LMS患者是否有生存获益。

方法

回顾性分析了来自2个三级中心（1993年至2009年）的95例经组织学证实的子宫LMS患者的数据。采用Kaplan-Meier法和Cox比例风险回归模型进行分析。

结果

平均年龄为51.5岁。36例（37.9%）患者接受了LND。淋巴结计数中位数为54个。8例（22.2%）患者发生了淋巴结转移。中位随访时间为26个月。62例（65%）患者复发，48例（50.5%）死亡。接受或未接受LND的两组患者的无病生存期（DFS）中位数均为19个月，总生存期（OS）中位数分别为29个月和26个月（P = 0.4）。两组患者的5年DFS分别为35.9%和26.8%（P = 0.4），5年OS分别为45.4%和43.8%（P = 0.22）。多因素分析未发现DFS或OS的单一独立预后因素。