子宫内膜样腺癌淋巴结切除术的变化趋势
Changing Trends in Lymphadenectomy for Endometrioid Adenocarcinoma of the Endometrium.
作者信息
Melamed Alexander, Rauh-Hain Jose A, Clemmer Joel T, Diver Elisabeth J, Hall Tracilyn R, Clark Rachel M, Uppal Shitanshu, Goodman Annekathryn, Boruta David M
机构信息
Vincent Department of Obstetrics, Gynecology and Reproductive Biology, Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, and the Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Michigan, Ann Arbor, Michigan.
出版信息
Obstet Gynecol. 2015 Oct;126(4):815-822. doi: 10.1097/AOG.0000000000001063.
OBJECTIVE
To describe trends in the use of lymphadenectomy for endometrioid adenocarcinoma of the endometrium between 1998 and 2012.
METHODS
A time-trend analysis was conducted using a population-based cancer registry covering 28% of the population of the United States. To quantify differences over the study period time, the frequency of lymphadenectomy and nodal metastasis among women who underwent surgical treatment of endometrioid endometrial adenocarcinoma was compared among consecutive 3- to 4-year periods. Biannual frequency of lymphadenectomy was modeled with Joinpoint regression to identify when potential changes in trends occurred and calculate annual percentage change.
RESULTS
A total of 74,365 women who underwent surgery between 1998 and 2012 were analyzed. Frequency of lymphadenectomy increased by 4.2% annually (95% confidence interval [CI] 3.7-4.6) from 1998 to 2007, after which the frequency declined by 1.6% per year (95% CI 0.9-2.2). Between 1998-2000 and 2007-2009, the frequency of lymphadenectomy rose from 48.7% to 65.5% (risk difference 16.8%, 95% CI 15.4-18.1), the proportion of women found to have nodal metastasis increased by 1.1% (95% CI 0.4-1.7), and the frequency of negative lymphadenectomy increased by 15.7% (95% CI 14.3-17.1). The decline in frequency of lymphadenectomy after 2007 was associated a 3.1% (95% CI 2.1-4.1) decline in the rate of negative lymphadenectomy, but no change in the proportion of women found to have nodal metastasis (P=.17).
CONCLUSION
The frequency of lymphadenectomy in the surgical treatment of endometrioid endometrial cancer increased by 4.2% annually from 1998 to 2007 and decreased by 1.6% annually from 2007 to 2012.
LEVEL OF EVIDENCE
II.
目的
描述1998年至2012年间子宫内膜样腺癌患者行淋巴结切除术的趋势。
方法
利用覆盖美国28%人口的基于人群的癌症登记系统进行时间趋势分析。为了量化研究期间的差异，比较了连续3至4年期间接受子宫内膜样腺癌手术治疗的女性中淋巴结切除术的频率和淋巴结转移情况。采用Joinpoint回归对淋巴结切除术的半年频率进行建模，以确定趋势的潜在变化发生时间并计算年度百分比变化。
结果
共分析了1998年至2012年间接受手术的74365名女性。1998年至2007年，淋巴结切除术的频率每年增加4.2%（95%置信区间[CI]3.7 - 4.6），此后频率每年下降1.6%（95% CI 0.9 - 2.2）。在1998 - 2000年和2007 - 2009年期间，淋巴结切除术的频率从48.7%上升至65.5%（风险差异16.8%，95% CI 15.4 - 18.1），发现有淋巴结转移的女性比例增加了1.1%（95% CI 0.4 - 1.7），阴性淋巴结切除术的频率增加了15.7%（95% CI 14.3 - 17.1）。2007年后淋巴结切除术频率的下降与阴性淋巴结切除率下降3.1%（95% CI 2.1 - 4.1）相关，但发现有淋巴结转移的女性比例无变化（P = 0.17）。
结论
1998年至2007年，子宫内膜样腺癌手术治疗中淋巴结切除术的频率每年增加4.2%，2007年至2012年每年下降1.6%。
证据级别
II级。
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