Ghanem Ahmed I, Khan Nadia T, Mahan Meredith, Ibrahim Ahmed, Buekers Thomas, Elshaikh Mohamed A
Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA.
Department of Public Health Science, Henry Ford Hospital, Detroit, MI, USA.
Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:225-230. doi: 10.1016/j.ejogrb.2016.12.033. Epub 2016 Dec 28.
The role of pelvic lymphadenectomy (LA) in women with stage I endometrial carcinoma (EC) is controversial. The objective of this study is to investigate the prognostic impact of LA on survival endpoints in matched cohorts of women with stage I EC solely of endometrioid histology. Survival endpoints included recurrence-free (RFS), disease-specific (DSS) and overall survival (OS).
Patients with FIGO stage I EC who underwent hysterectomy with LA as part of their surgical staging between 1/1990 and 6/2015 were matched to a similar group that underwent hysterectomy without lymphadenectomy (NLA), based on stage, grade and adjuvant management. Univariate and multivariate modeling with Cox regression analysis was carried out for predictors of survival endpoints.
870 women constituted the study cohort (435 in each group). Median number of dissected lymph node in the LA group was 9 (range, 5-75). There was no statistically significant difference between the two groups in regards to 5-year OS (87.2% for LA vs. 91.7% for NLA) (p=0.36), DSS 97.7% vs. 98% (p=0.54) and RFS (93.7% vs. 90% (p=0.08), respectively. Lymphadenectomy was not a predictor of any of the studied survival endpoints. On multivariate analysis for the entire cohort, older age, deep myometrial invasion and higher tumor grade were predictors of worse RFS. For DSS, higher tumor grade, lower uterine segment (LUS) involvement and FIGO stage IB were significant predictors of worse outcome. For OS, older age and LUS involvement were the only two independent predictors for shorter OS.
After matching for FIGO stage, grade and adjuvant management, it appears that lymphadenectomy in women with stage I EC does not impact survival endpoints.
盆腔淋巴结切除术（LA）在Ⅰ期子宫内膜癌（EC）女性患者中的作用存在争议。本研究的目的是探讨LA对仅为子宫内膜样组织学的Ⅰ期EC女性匹配队列生存终点的预后影响。生存终点包括无复发生存期（RFS）、疾病特异性生存期（DSS）和总生存期（OS）。
1990年1月至2015年6月期间接受子宫切除术及LA作为手术分期一部分的FIGO Ⅰ期EC患者，根据分期、分级和辅助治疗情况，与一组接受无淋巴结切除术（NLA）子宫切除术的类似患者进行匹配。采用Cox回归分析对生存终点的预测因素进行单变量和多变量建模。
870名女性构成研究队列（每组435名）。LA组切除淋巴结的中位数为9个（范围5 - 75个）。两组在5年总生存期（LA组为87.2%，NLA组为91.7%）（p = 0.36）、疾病特异性生存期（97.7%对98%）（p = 0.54）和无复发生存期（分别为93.7%对90%）（p = 0.08）方面无统计学显著差异。淋巴结切除术不是任何所研究生存终点的预测因素。对整个队列进行多变量分析时，年龄较大、肌层浸润深度和肿瘤分级较高是无复发生存期较差的预测因素。对于疾病特异性生存期，肿瘤分级较高、子宫下段（LUS）受累及FIGO ⅠB期是预后较差的显著预测因素。对于总生存期，年龄较大和LUS受累是总生存期较短的仅有的两个独立预测因素。
在对FIGO分期、分级和辅助治疗进行匹配后，Ⅰ期EC女性的淋巴结切除术似乎不会影响生存终点。
