Holloway Robert W, Gupta Sarika, Stavitzski Nicole M, Zhu Xiang, Takimoto Erica L, Gubbi Ajit, Bigsby Glenn E, Brudie Lorna A, Kendrick James E, Ahmad Sarfraz
Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, FL 32804, USA.
Gynecol Oncol. 2016 May;141(2):206-210. doi: 10.1016/j.ygyno.2016.02.018. Epub 2016 Mar 2.
To compare the performance of sentinel lymph node (SLN) mapping with staging lymphadenectomy versus staging lymphadenectomy alone for the detection of metastasis and the use of adjuvant therapies in patients with endometrial cancer.
All patients with apparent early-stage endometrial cancer (n=780) who underwent robotic-assisted hysterectomy with pelvic±aortic lymphadenectomy from July-2006 to June-2013 were compared [pelvic±aortic lymphadenectomy (n=661) versus SLN-mapped cases with pelvic±aortic lymphadenectomy (n=119)]. Isosulfan-blue and indocyanine-green with near-infrared imaging were used for SLN mapping. Clinico-pathological data, FIGO stage, GOG risk category, and adjuvant therapies were compared.
Non-mapped and mapped cases were comparable with respect to BMI, histology, depth-of-invasion, and lympho-vascular space invasion. The mapped group had more pelvic lymph node (LN) harvested compared to non-mapped group (26.4±10.5 vs. 18.8±8.5, p<0.001). Aortic LN yields were identical for both groups (9.0±5.6 vs. 9.0±6.0). The mapped group had more LN metastasis detected (30.3% vs. 14.7%, p<0.001), more stage IIIC (30.2% vs. 14.5%, p<0.001), more GOG high-risk cases (32.8% vs. 21.8%, p=0.013), and received more chemotherapy+radiation (28.6% vs. 16.3%, p<0.003). The SLN was the only metastasis in 18 (50%) mapped cases with positive nodes. The SLN false negative rate was 1/36 (2.8%). Micrometastases or isolated tumor cells were identified in 22/35 (62.9%) SLN metastases. Multivariate analysis demonstrated that SLN mapping imparted a significant effect on the detection of metastatic disease [adjusted OR=3.29, p<0.001].
The performance of SLN mapping with staging lymphadenectomy increased the detection of lymph node metastasis and was associated with more use of adjuvant therapies.
比较前哨淋巴结（SLN）定位联合分期淋巴结清扫术与单纯分期淋巴结清扫术在子宫内膜癌患者转移灶检测及辅助治疗应用方面的表现。
比较2006年7月至2013年6月期间接受机器人辅助子宫切除术及盆腔±主动脉旁淋巴结清扫术的所有早期子宫内膜癌患者（n = 780）[盆腔±主动脉旁淋巴结清扫术（n = 661）与SLN定位联合盆腔±主动脉旁淋巴结清扫术的病例（n = 119）]。使用异硫蓝和近红外成像的吲哚菁绿进行SLN定位。比较临床病理数据、国际妇产科联盟（FIGO）分期、妇科肿瘤学组（GOG）风险类别及辅助治疗情况。
未定位组和定位组在体重指数、组织学、浸润深度及淋巴血管间隙浸润方面具有可比性。与未定位组相比，定位组切除的盆腔淋巴结（LN）更多（26.4±10.5 vs. 18.8±8.5，p<0.001）。两组的主动脉旁LN收获量相同（9.0±5.6 vs. 9.0±6.0）。定位组检测到的LN转移更多（30.3% vs. 14.7%，p<0.001），IIIC期更多（30.2% vs. 14.5%，p<0.001），GOG高危病例更多（32.8% vs. 21.8%，p = 0.013），且接受化疗+放疗的更多（28.6% vs. 16.3%，p<0.003）。在18例（50%）SLN阳性的定位病例中，SLN是唯一的转移灶。SLN假阴性率为1/36（2.8%）。在35例SLN转移中，22例（62.9%）发现微转移或孤立肿瘤细胞。多因素分析表明，SLN定位对转移疾病的检测有显著影响[校正比值比=3.29，p<0.001]。
SLN定位联合分期淋巴结清扫术提高了淋巴结转移的检测率，并与更多辅助治疗的应用相关。
