Ducie Jennifer A, Eriksson Ane Gerda Zahl, Ali Narisha, McGree Michaela E, Weaver Amy L, Bogani Giorgio, Cliby William A, Dowdy Sean C, Bakkum-Gamez Jamie N, Soslow Robert A, Keeney Gary L, Abu-Rustum Nadeem R, Mariani Andrea, Leitao Mario M
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2017 Dec;147(3):541-548. doi: 10.1016/j.ygyno.2017.09.030. Epub 2017 Sep 29.
To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate-/high-risk endometrial carcinoma.
Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive.
We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P=0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P=0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate-/high-risk groups in the LND cohort (P<0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P=0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P=0.76).
SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND.
确定前哨淋巴结（SLN）定位算法能否检测出中/高危子宫内膜癌患者的淋巴结转移疾病。
在两个合作机构对患者进行识别并进行手术分期。一个机构的历史队列（2004 - 2008年）包括接受至肾静脉水平的盆腔和腹主动脉旁淋巴结清扫术的患者（淋巴结清扫术队列）。在第二个机构，实施了包括病理超分期的SLN定位算法（2叭6 - 2013年）（SLN队列）。中危定义为子宫内膜样组织学（任何分级）、肌层浸润≥50%；高危定义为浆液性或透明细胞组织学（任何肌层浸润）。有肉眼可见腹膜疾病的患者被排除。孤立肿瘤细胞、微转移和宏转移均视为淋巴结阳性。
我们在淋巴结清扫术队列中识别出210例患者，在SLN队列中识别出202例患者。对大多数患者进行了淋巴结评估。在中危组，IIIc期疾病在30/107（28.0%）（淋巴结清扫术队列）、29/82（35.4%）（SLN队列）中被诊断出（P = 0.28）。在高危组，IIIc期疾病在20/l03（19.4%）（淋巴结清扫术队列）、26/（21.7%）（SLN队列）中被诊断出（P = 0.68）。在淋巴结清扫术队列的中/高危组中，腹主动脉旁淋巴结评估的实施频率显著更高（P<0.001）。在中危组，腹主动脉旁淋巴结转移在20/96（20.8%）（淋巴结清扫术队列）与3/28（10.7%）（SLN队列）中被检测到（P = 0.23）。在高危组，腹主动脉旁淋巴结转移在13/82（15.9%）（淋巴结清扫术队列）和10/56（17.9%）（SLN队列）中被检测到（P = 0.76）。
SLN定位算法对IIIc期子宫内膜癌的检测率相似。与标准淋巴结清扫术相比，SLN算法不会影响总体检测效果。
