Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States.
School of Medicine, University of Rochester, Rochester, NY, United States.
Gynecol Oncol. 2018 Jun;149(3):531-538. doi: 10.1016/j.ygyno.2018.03.046. Epub 2018 Mar 17.
To determine, in patients with non-endometrioid endometrial carcinoma, 1) survival benefit associated with pelvic lymphadenectomy (LND), 2) survival benefit for para-aortic lymphadenectomy performed in addition to pelvic lymphadenectomy, and 3) association between number of lymph nodes removed and survival.
Patients with clinical stage I serous carcinoma, clear cell carcinoma, or carcinosarcoma who underwent hysterectomy from 2010 to 2013 were identified from the National Cancer Database. Hazard ratio (HR) for death was assessed using propensity score-weighted multivariable Cox regression models. Subgroup analyses assessed for differences in risk of death among histologic subtypes.
7250 patients met study criteria. 930 (13%) did not undergo LND; 2177 (30%) underwent pelvic LND alone; 4143 (57%) underwent pelvic+para-aortic LND. On propensity score-weighted analysis, pelvic LND was associated with decreased risk of death (HR=0.65, 95% CI: 0.59-0.71) compared to no LND. Pelvic+para-aortic LND was associated with decreased risk of death (HR=0.85, 95% CI: 0.79-0.91) compared to pelvic LND for patients with serous carcinoma. Removal of >15 nodes was independently associated with decreased HR for death (HR=0.86, 95% CI: 0.77-0.96); this association persisted when analysis was limited to patients with node-positive disease (HR=0.78, 95% CI: 0.63-0.95).
LND is associated with survival benefit in patients with non-endometrioid endometrial cancers. Addition of para-aortic LND to pelvic LND may be most beneficial for patients with serous carcinoma. Systematic lymphadenectomy may be associated with survival benefit through detection and microscopic cytoreduction of occult disease.
在非子宫内膜样子宫内膜癌患者中，1）评估盆腔淋巴结清扫术（LND）相关的生存获益，2）评估盆腔淋巴结清扫术基础上增加腹主动脉旁淋巴结清扫术的生存获益，以及 3）评估清扫淋巴结数目与生存的相关性。
从国家癌症数据库中确定了 2010 年至 2013 年接受子宫切除术的临床 I 期浆液性癌、透明细胞癌或癌肉瘤患者。使用倾向评分加权多变量 Cox 回归模型评估死亡的风险比（HR）。亚组分析评估了组织学亚型之间死亡风险的差异。
7250 名患者符合研究标准。930 名（13%）患者未行 LND；2177 名（30%）患者仅行盆腔 LND；4143 名（57%）患者行盆腔+腹主动脉旁 LND。经倾向评分加权分析，与未行 LND 相比，盆腔 LND 降低了死亡风险（HR=0.65，95%CI：0.59-0.71）。与盆腔 LND 相比，盆腔+腹主动脉旁 LND 降低了浆液性癌患者的死亡风险（HR=0.85，95%CI：0.79-0.91）。清除>15 枚淋巴结与降低死亡风险的 HR 独立相关（HR=0.86，95%CI：0.77-0.96）；当分析仅限于淋巴结阳性疾病患者时，这种相关性仍然存在（HR=0.78，95%CI：0.63-0.95）。
LND 与非子宫内膜样子宫内膜癌患者的生存获益相关。在盆腔 LND 基础上增加腹主动脉旁 LND 可能对浆液性癌患者最有益。系统淋巴结清扫术可能通过检测和显微镜下减瘤来与生存获益相关。
