Ouldamer L, Bendifallah S, Body G, Canlorbe G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M
Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.
INSERM U1069, Université François-Rabelais, Tours, France.
Ann Surg Oncol. 2017 Jun;24(6):1660-1666. doi: 10.1245/s10434-016-5731-0. Epub 2017 Jan 5.
The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC.
We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with <50% myometrial invasion regardless of LVSI status), who received primary surgical treatment between January 2001 and December 2013. We recorded frequency of lymph node (LN) metastases in those who underwent nodal staging. The secondary outcomes were overall survival and recurrence patterns.
Overall, 145 (80.1%) women underwent nodal staging consisting of at least pelvic lymphadenectomy. Of these, 62 (42.7%) had LN disease (9.7% with micrometastases). The respective 5-year overall survival rates according to LN status were 85.0% (95% confidence interval [CI] 76.5-91.4), 71.8% (95% CI 61.9-80.4) and 36.0% (95% CI 26.6-46.2) for women with negative LN, positive LN, and unstaged (p = 0.047). Unstaged women were more likely to experience nodal recurrence than surgically staged/LN negative women (p = 0.05).
Systematic nodal staging should be part of surgical staging for women with apparent ESMO/ESGO/ESTRO HIR EC. Sentinel LN biopsy (SLNB) could be an option in this specific setting that may possibly substitute comprehensive staging, for the identification of patients with lymphatic dissemination.
欧洲医学肿瘤学会（ESMO）/欧洲妇科肿瘤学会（ESGO）/欧洲放射肿瘤学会（ESTRO）的子宫内膜癌（EC）分类现在包括一个高中风险（HIR）复发组，因为淋巴管间隙浸润（LVSI）和中风险女性的3级具有不良预后作用。然而，最佳手术分期，尤其是淋巴结切除术的地位，仍有待阐明。我们旨在确定系统性淋巴结分期是否应成为HIR EC女性手术分期的一部分。
我们从一个前瞻性维护的多中心数据库中提取了181例基于子宫因素的HIR EC女性的数据（子宫内膜样1型、1-2级肿瘤伴深部（≥50%）肌层浸润且LVSI明确阳性，以及3级肿瘤伴<50%肌层浸润且无论LVSI状态如何的女性），这些女性在2001年1月至2013年12月期间接受了初次手术治疗。我们记录了接受淋巴结分期的患者的淋巴结（LN）转移频率。次要结局为总生存期和复发模式。
总体而言，145例（80.1%）女性接受了至少包括盆腔淋巴结切除术的淋巴结分期。其中，62例（42.7%）有LN疾病（9.7%为微转移）。LN状态为阴性、阳性和未分期的女性的5年总生存率分别为85.0%（95%置信区间[CI]76.5-91.4）、71.8%（95%CI 61.9-80.4）和36.0%（95%CI 26.6-46.2）（p = 0.047）。未分期的女性比接受手术分期/LN阴性的女性更有可能发生淋巴结复发（p = 0.05）。
对于明显的ESMO/ESGO/ESTRO HIR EC女性，系统性淋巴结分期应成为手术分期的一部分。前哨淋巴结活检（SLNB）可能是这种特定情况下的一种选择，有可能替代全面分期，用于识别有淋巴扩散的患者。
