Stålberg K, Kjølhede P, Bjurberg M, Borgfeldt C, Dahm-Kähler P, Falconer H, Holmberg E, Staf C, Tholander B, Åvall-Lundqvist E, Rosenberg P, Högberg T
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Obstetrics and Gynecology, Linköpings Universitet, Linköping, Sweden.
Int J Cancer. 2017 Jun 15;140(12):2693-2700. doi: 10.1002/ijc.30707. Epub 2017 Apr 12.
The role of lymphadenectomy in the management of early endometrial cancer remains controversial. In the recent ESMO-ESGO-ESTRO guidelines, lymphadenectomy is recommended for patients with endometrioid adenocarcinoma Grade 3 with deep myometrial invasion, but complete agreement was not achieved. In Sweden, DNA aneuploidy has been included as a high-risk factor. The aim of our study was to evaluate the impact of tumor histology, FIGO grade, DNA ploidy and myometrial invasion (MI) on occurrence of lymph node metastasis (LNM) in patients with endometrial cancer. The study design is a retrospective cohort study based on prospectively recorded register data. Endometrial cancer patients registered in the Swedish Quality Registry for Gynecologic Cancer 2010-2015 with FIGO Stages I-III and verified nodal status were included. Data on DNA ploidy, histology, FIGO grade and MI were included in multivariable log-binomial regression analyses with LNM as dependent variable. 1,165 cases fulfilled the inclusion criteria. The multivariable analyses revealed increased risk of LNM in patients with tumors with MI ≥ 50% (risk ratio [RR] = 4.1; 95% confidence interval [CI] 3.0-5.6), nonendometrioid compared to endometrioid histology (RR 1.8; CI 1.4-2.4) and FIGO Grade 3 compared to Grade 1-2 tumors (RR 1.5; CI 1.1-2.0). No statistically significant association between DNA ploidy status and LNM was detected. This population-based, nation-wide study in women with endometrial cancer confirms a strong association between MI ≥ 50%, nonendometrioid histology and FIGO Grade 3, respectively, and LNM. DNA ploidy should not be included in the preoperative decision making of removing nodes or not.
淋巴结切除术在早期子宫内膜癌治疗中的作用仍存在争议。在最近的欧洲肿瘤内科学会（ESMO）-欧洲妇科肿瘤学会（ESGO）-欧洲放射肿瘤学会（ESTRO）指南中，对于具有深肌层浸润的3级子宫内膜样腺癌患者推荐进行淋巴结切除术，但并未达成完全一致意见。在瑞典，DNA非整倍体已被列为高危因素。我们研究的目的是评估肿瘤组织学、国际妇产科联盟（FIGO）分级、DNA倍体和肌层浸润（MI）对子宫内膜癌患者淋巴结转移（LNM）发生情况的影响。研究设计是一项基于前瞻性记录登记数据的回顾性队列研究。纳入2010 - 2015年在瑞典妇科癌症质量登记处登记的FIGO分期为I - III期且淋巴结状态已核实的子宫内膜癌患者。将DNA倍体、组织学、FIGO分级和MI的数据纳入以LNM为因变量的多变量对数二项回归分析。1165例病例符合纳入标准。多变量分析显示，MI≥50%的肿瘤患者发生LNM的风险增加（风险比[RR]=4.1；95%置信区间[CI] 3.0 - 5.6），非子宫内膜样组织学与子宫内膜样组织学相比（RR 1.8；CI 1.4 - 2.4），以及FIGO 3级与1 - 2级肿瘤相比（RR 1.5；CI 1.1 - 2.0）。未检测到DNA倍体状态与LNM之间存在统计学显著关联。这项基于人群的全国性子宫内膜癌女性研究证实，MI≥50%、非子宫内膜样组织学和FIGO 3级分别与LNM之间存在密切关联。DNA倍体不应纳入术前是否切除淋巴结的决策中。
