How Jeffrey, Gauthier Caroline, Abitbol Jeremie, Lau Susie, Salvador Shannon, Gotlieb Raphael, Pelmus Manuela, Ferenczy Alex, Probst Stephan, Brin Sonya, Fatnassi Asma, Gotlieb Walter
Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada.
Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec H2T 1E2, Canada.
Gynecol Oncol. 2017 Mar;144(3):503-509. doi: 10.1016/j.ygyno.2017.01.013. Epub 2017 Jan 16.
Sentinel lymph node (SLN) mapping has emerged as a promising solution to the ongoing debate regarding lymphadenectomy in the initial surgical management of endometrial cancer. Currently, little is known about its possible impact on location of disease recurrence compared to systematic lymphadenectomy.
In this retrospective study, 472 consecutive patients with endometrial cancer who underwent either SLN mapping (SLN cohort, n=275) or systematic lymphadenectomy (LND cohort, n=197) from sequential, non-overlapping historical time points were compared. Clinical characteristics were extracted from a prospectively gathered electronic database. Both overall and pelvic sidewall recurrence free survival (RFS) were evaluated at 48-month post-operative follow-up.
No significant difference in overall RFS could be identified between the cohorts at 48months (HR 0.74, 95% CI 0.43-1.28, p=0.29). However, the SLN cohort had improved pelvic sidewall RFS compared to the LND cohort (HR 0.32, 95% CI 0.14-0.74, p=0.007). The pelvic sidewall recurrences accounted for 30% of recurrences in the SLN cohort (8 out of 26 recurrences) compared to 71.4% in the LND cohort (20 out of 28 recurrences).
SLN mapping may enable more efficient detection of the LNs at greatest risk of metastasis and help to guide adjuvant therapy, which in turn seems to decrease the risk of pelvic sidewall recurrences.
前哨淋巴结（SLN）定位已成为解决子宫内膜癌初始手术治疗中关于淋巴结清扫的持续争论的一个有前景的解决方案。目前，与系统性淋巴结清扫相比，其对疾病复发部位的可能影响知之甚少。
在这项回顾性研究中，比较了从连续的、不重叠的历史时间点接受SLN定位（SLN队列，n = 275）或系统性淋巴结清扫（LND队列，n = 197）的472例连续子宫内膜癌患者。临床特征从前瞻性收集的电子数据库中提取。在术后48个月的随访中评估总体和盆腔侧壁无复发生存率（RFS）。
在48个月时，各队列之间的总体RFS无显著差异（HR 0.74，95%CI 0.43 - 1.28，p = 0.29）。然而，与LND队列相比，SLN队列的盆腔侧壁RFS有所改善（HR 0.32，95%CI 0.14 - 0.74，p = 0.007）。盆腔侧壁复发占SLN队列复发的30%（26例复发中的8例），而在LND队列中占71.4%（28例复发中的20例）。
SLN定位可能能够更有效地检测转移风险最高的淋巴结，并有助于指导辅助治疗，这反过来似乎降低了盆腔侧壁复发的风险。
