Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam.
Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
Int J Gynecol Cancer. 2018 Jul;28(6):1123-1129. doi: 10.1097/IGC.0000000000001270.
Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection.
Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ≤35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method.
The median patient age was 52 years (range, 24-86 years). The median follow-up was 59 months (range, 0-189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%-100.0%) and 98.6% (95% CI, 96.7%-100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk.
Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.
随机研究并未显示常规淋巴结清扫术对早期子宫内膜癌患者有生存获益。然而，许多外科医生仍对所有早期子宫内膜癌患者进行淋巴结清扫术。本研究旨在确定未行淋巴结清扫术的极低危子宫内膜癌患者（根据韩国妇科肿瘤学组[KGOG]标准）的生存结局。
从 10 家机构收集了 156 例连续接受手术分期且未行淋巴结清扫术的患者的病历。所有患者均符合 KGOG 标准：（1）术前子宫内膜活检诊断为子宫内膜样腺癌；（2）血清癌抗原 125 水平≤35IU/mL；（3）磁共振成像（MRI）显示<50%的子宫肌层浸润，且无子宫体外延伸；（4）MRI 或计算机断层扫描显示淋巴结短径<1.0cm 的淋巴结<5 个。允许外科医生根据情况选择<5 个淋巴结进行取样。我们使用 Kaplan-Meier 法评估 3 年无复发生存率（RFS）和 5 年总生存率（OS）。
中位患者年龄为 52 岁（范围，24-86 岁）。中位随访时间为 59 个月（范围，0-189 个月）。3 年 RFS 和 5 年 OS 分别为 98.6%（95%可信区间[CI]，96.8%-100.0%）和 98.6%（95% CI，96.7%-100.0%）。无疾病相关死亡。最终病理报告显示 29 例（18.6%）患者有≥50%的子宫肌层浸润，2 例（1.3%）患者有子宫体外延伸。1 例（0.6%）患者在淋巴结取样后被诊断为淋巴结转移。18 例（11.5%）患者在最终病理结果显示高危后接受了辅助治疗。
未行淋巴结清扫术的极低危患者具有可接受的生存结局。在符合 KGOG 标准的患者中，省略淋巴结清扫术可能是合理的。
