Aşıcıoğlu Osman, Gungorduk Kemal, Ozdemir Aykut, Güngördük Özgü, Gokçü Mehmet, Yaşar Levent, Sancı Muzaffer
a Department of Gynecologic Oncology , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey.
b Department of Gynecologic Oncology , Mugla Sıtkı Kocman University Education and Research Hospital , Mugla , Turkey.
J Obstet Gynaecol. 2019 Jan;39(1):105-109. doi: 10.1080/01443615.2018.1467884. Epub 2018 Sep 6.
The purpose of this study was to develop a model predicting the probability of pelvic-paraaortic node metastases in high-risk endometrial cancer patients. This trial included 41 high-risk endometrial cancer patients. All of the patients underwent an 18-FDG PET-CT followed by surgical staging, including a pelvic and paraaortic lymphadenectomy. We developed a useful scoring system combining weighted risk factors derived from a regression model: (3 × presence PET-CT involvement) + (3 × PET-CT maximum standardised uptake value ≥20) + (2 × diabetes comorbidity) + (1 × age ≥60 years) + (1 × body mass index ≥30). The area under the curve of the resulting score was 0.848. There was 75% sensitivity, 89% specificity and a 75% positive predictive value and 89% negative predictive value when a score of 6 was used as the cut-off. Our novel preoperative scoring system is an accurate method for the preoperative evaluation of lymph node metastases, and thus will aid gynaecological oncologists in selecting EC patients who may benefit from a lymphadenectomy. Impact statement What is already known on this subject? Endometrial cancer (EC) is a common gynaecological malignancy. Surgical staging is currently the standard treatment and the gold standard for evaluating lymph node metastases (LNm) is a surgical assessment (Chan et al. 2006 ). Three previous randomised clinical studies failed to find a clear therapeutic role for the lymphadenectomy; thus, the utility of this surgical procedure in high-risk early-stage EC remains under debate (Benedetti Panici et al. 2008 ; Kitchener et al. 2009 ; Signorelli et al. 2015 ). Non-invasive techniques that accurately identify lymph node metastases would reduce costs and complications. What do the results of this study add? Our developed novel scoring system that is based on positron emission tomography-computer tomography (PET-CT) with 2-deoxy-2-(18F) flouro-2-D-glucose (FDG) may facilitate the identification of patients at an increased risk of LNm. What are the implications of these finding for clinical practice and/or further research? This study shows that our novel preoperative scoring system provides an accurate method for the preoperative evaluation of LNm, and thus could guide gynaecologic oncologists in selecting the high-risk endometrial cancer patients who may benefit from a systematic lymphadenectomy. Further larger, prospective studies are needed to confirm the accuracy and the feasibility of our scoring system.
本研究的目的是建立一个模型，用于预测高危子宫内膜癌患者盆腔-腹主动脉旁淋巴结转移的概率。该试验纳入了41例高危子宫内膜癌患者。所有患者均接受了18F-FDG PET-CT检查，随后进行手术分期，包括盆腔和腹主动脉旁淋巴结清扫术。我们开发了一种有用的评分系统，该系统结合了从回归模型得出的加权风险因素：（3×PET-CT受累情况）+（3×PET-CT最大标准化摄取值≥20）+（2×合并糖尿病）+（1×年龄≥60岁）+（1×体重指数≥30）。所得分数的曲线下面积为0.848。以6分为临界值时，敏感性为75%，特异性为89%，阳性预测值为75%，阴性预测值为89%。我们新的术前评分系统是术前评估淋巴结转移的一种准确方法，因此将有助于妇科肿瘤学家选择可能从淋巴结清扫术中获益的子宫内膜癌患者。影响声明关于该主题已知的信息有哪些？子宫内膜癌（EC）是一种常见的妇科恶性肿瘤。手术分期是目前的标准治疗方法，评估淋巴结转移（LNm）的金标准是手术评估（Chan等人，2006年）。之前的三项随机临床研究未能发现淋巴结清扫术有明确的治疗作用；因此，这种手术在高危早期EC中的效用仍存在争议（Benedetti Panici等人，2008年；Kitchener等人，2009年；Signorelli等人，2015年）。准确识别淋巴结转移的非侵入性技术将降低成本和并发症。这项研究的结果增加了什么？我们开发的基于正电子发射断层扫描-计算机断层扫描（PET-CT）和2-脱氧-2-（18F）氟-D-葡萄糖（FDG）的新评分系统可能有助于识别LNm风险增加的患者。这些发现对临床实践和/或进一步研究有何意义？这项研究表明，我们新的术前评分系统为术前评估LNm提供了一种准确方法，因此可以指导妇科肿瘤学家选择可能从系统性淋巴结清扫术中获益的高危子宫内膜癌患者。需要进一步进行更大规模的前瞻性研究来证实我们评分系统的准确性和可行性。
