子宫内膜癌——有多少患者可能受益于前哨淋巴结清扫术？
Endometrial cancer-how many patients could benefit from sentinel lymph node dissection?
机构信息
Rotkreuzklinikum München, Frauenklinik Taxisstraße 3, 80637, München, Germany.
Pathologie Rotkreuzklinikum, Winthirstraße 11, 80639, München, Germany.
出版信息
World J Surg Oncol. 2018 May 17;16(1):95. doi: 10.1186/s12957-018-1392-8.
BACKGROUND
Sentinel lymph node dissection (SLND) may reduce morbidity in patients with endometrial cancer. The objective of this study is to estimate how many systematic lymph node dissections (LND) can be spared with an implementation of a SLN-procedure.
METHODS
Retrospective, single-center study, SLND according to NCCN-Guidelines.
RESULTS
In 109 patients of 154 consecutive patients, SLND was performed. The detection rate was 61% on both sides and 86% on at least one side. Classification of uterine risk factors is as follows: low risk 53, intermediate risk 25, high-intermediate risk 13, and high-risk 18. Stage IIIC: 0, 3, 7, 11, respectively. Under the assumption that 56 patients with "higher than low risk" factors would be treated by systematic LND, we spared 26 pelvic and paraaortic LND. After failures of SLN detection, unilateral pelvic LND was performed in 15 patients. Patients with "higher than low risk" factors and node-negative SLN are candidates for a randomized study to prove safety and efficacy. Only every third patient in our study met these criteria.
CONCLUSIONS
In a cohort of patients with "higher than low risk" endometrial cancer, the implementation of SLND nearly divided the number of radical lymph node dissections in half. Further studies are required to define the best modalities for SLND.
背景
前哨淋巴结清扫术 (SLND) 可能降低子宫内膜癌患者的发病率。本研究旨在评估实施 SLN 手术可以节省多少系统性淋巴结清扫术 (LND)。
方法
回顾性、单中心研究，根据 NCCN 指南进行 SLND。
结果
在 154 例连续患者中的 109 例患者中进行了 SLND。双侧检出率为 61%，至少一侧为 86%。子宫危险因素分类如下：低危 53 例，中危 25 例，中高危 13 例，高危 18 例。ⅡIC 期：分别为 0、3、7、11。假设 56 例“高危因素”患者接受系统性 LND 治疗，我们节省了 26 例盆腔和腹主动脉旁 LND。SLN 检测失败后，15 例患者行单侧盆腔 LND。具有“高危因素”和淋巴结阴性 SLN 的患者是随机研究安全性和疗效的候选者。在我们的研究中，只有每三个患者符合这些标准。
结论
在“高危因素”子宫内膜癌患者队列中，实施 SLND 可使根治性淋巴结清扫术的数量减少近一半。需要进一步研究以确定 SLND 的最佳方式。
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