Department of Gynecology, Copenhagen University Hospital, Copenhagen, Denmark
Department of Gynecology, Copenhagen University Hospital, Copenhagen, Denmark.
Int J Gynecol Cancer. 2019 Jan;29(1):68-76. doi: 10.1136/ijgc-2018-000023.
To evaluate the rate of survival and recurrence related to the introduction of pelvic lymphadenectomy in Danish high-risk endometrial cancer patients.
Data on 713 high-risk patients defined as grade 3 with >50% myometrial invasion or serous/clear/undifferentiated carcinomas stage I-IV endometrial cancer patients diagnosed from 2005 to 2012 were retrieved from the Danish Gynecological Cancer Database. Of these, 305 were high-risk stage I. Five year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox used for comparison. Findings were compared with earlier Danish results.
Lymphadenectomy in 390 radically operated high-risk patients resulted in upstaging of 31 patients from stage I to IIIC and 19 patients from stage II to IIIC corresponding to 12.8%. Upstaging from stage I to IIIC had a cancer-specific survival of 77%, almost comparable to lymph node-negative high-risk stage I patients (81%). Lymphadenectomy patients had a significant higher overall survival as compared with non-lymph node resected for all patients, but not for stage I patients. Lymphadenectomy, however, did not significantly affect cancer-specific survival, progression-free survival, recurrence rate or risk of local, distant, or lymph node recurrence. When the survival of high-risk stage I patients was compared with earlier Danish results, a small improvement in overall survival (7%) and cancer-specificsurvival (8%) was demonstrated.
Only a small number of high-risk patients were upstaged from stage I to III due to lymphadenectomy. These patients showed a surprisingly good survival possibly due to correct stage identification and subsequent relevant adjuvant therapy. However, even though introduction of lymphadenectomy in the Danish high-risk population seems to increase overall survival, no significant change in cancer-specific survival, progression-free survival or recurrence patterns was demonstrated.
评估在丹麦高危子宫内膜癌患者中引入盆腔淋巴结切除术相关的生存率和复发率。
从丹麦妇科癌症数据库中检索了 2005 年至 2012 年间诊断为 3 级且肌层浸润>50%或浆液性/透明性/未分化癌 I-IV 期子宫内膜癌的 713 名高危患者的数据。其中 305 名为高危 I 期患者。计算了 5 年 Kaplan-Meier 生存估计和实际复发率，并使用调整后的 Cox 进行比较。结果与丹麦早期结果进行了比较。
对 390 名接受根治性手术的高危患者进行淋巴结切除术，导致 31 名患者从 I 期升级为 IIIIC 期，19 名患者从 II 期升级为 IIIIC 期，占 12.8%。从 I 期升级为 IIIIC 期的患者癌症特异性生存率为 77%，与淋巴结阴性高危 I 期患者（81%）几乎相当。与所有患者相比，淋巴结切除术患者的总生存率显著提高，但与 I 期患者相比则不然。然而，淋巴结切除术并未显著影响癌症特异性生存率、无进展生存率、复发率或局部、远处或淋巴结复发的风险。当高危 I 期患者的生存率与丹麦早期结果进行比较时，显示出总生存率（7%）和癌症特异性生存率（8%）略有提高。
只有少数高危患者因淋巴结切除术从 I 期升级为 III 期。这些患者的生存率令人惊讶地好，可能是由于正确的分期识别和随后的相关辅助治疗。然而，尽管在丹麦高危人群中引入淋巴结切除术似乎提高了总生存率，但并未显示出癌症特异性生存率、无进展生存率或复发模式的显著变化。
