盆腔及腹主动脉旁淋巴结切除术与Ⅰ期子宫内膜样子宫内膜癌生存率的关联：来自国家癌症数据库的匹配队列分析
Association of Pelvic and Para-Aortic Lymphadenectomy With Survival in Stage I Endometrioid Endometrial Cancer: Matched Cohort Analyses From the National Cancer Database.
作者信息
Seagle Brandon-Luke L, Kocherginsky Masha, Shahabi Shohreh
机构信息
All authors: Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
JCO Clin Cancer Inform. 2017 Nov;1:1-14. doi: 10.1200/CCI.17.00028.
PURPOSE
To estimate whether pelvic and para-aortic lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer.
METHODS
We performed matched cohort analyses of women with stage I endometrioid endometrial cancer who underwent hysterectomy with no lymphadenectomy, pelvic lymphadenectomy, or combined pelvic and para-aortic lymphadenectomy. Cox proportional hazards survival analyses were performed with inverse probability weights. Hazard ratios (HRs) were covariate and propensity score adjusted. Covariates included cancer center type, age, race, Hispanic ethnicity, insurance type, community median income quartile, comorbidity score, history of prior cancer, depth of myometrial invasion, tumor grade, tumor size, lymphovascular space invasion, cytology status, surgical margin status, hospital volume, and use of adjuvant radiotherapy or chemotherapy. Additional analyses included subset analyses by grade, sensitivity analyses with imputation of missing data, and testing for sensitivity to possible unmeasured confounding.
RESULTS
Median (interquartile range [IQR]) lymph node counts were 0, 10 (5-15), and 20 (15-27) nodes in the no lymphadenectomy, pelvic, and combined pelvic and para-aortic lymphadenectomy-matched cohorts, respectively. Matched cohorts were well balanced. Two analyses were performed: no lymphadenectomy (n = 7,487) versus pelvic lymphadenectomy (n = 7,487), and pelvic lymphadenectomy (n = 7,060) versus combined pelvic and para-aortic lymphadenectomy (n = 7,060). Performance of pelvic lymphadenectomy was associated with increased survival compared with no lymphadenectomy (5-year survival [95% CI], 91.4% [90.2% to 92.6%] v 87.3% [85.9% to 88.8%]; HR, 0.71 [95% CI, 0.64 to 0.78]; P < .001). Addition of para-aortic lymphadenectomy was associated with increased survival compared with pelvic lymphadenectomy alone (5-year survival [95% CI], 91.0% [89.8% to 92.2%] v 89.8% [88.4% to 91.1%]; HR, 0.85 [95% CI, 0.77 to 0.95]; P = .003). Associations were robust to sensitivity analyses.
CONCLUSION
Lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. An adequately powered randomized trial is needed.
目的
评估盆腔及腹主动脉旁淋巴结切除术是否与I期子宫内膜样腺癌患者生存率的提高相关。
方法
我们对接受子宫切除术的I期子宫内膜样腺癌女性患者进行了匹配队列分析，这些患者分别未接受淋巴结切除术、接受盆腔淋巴结切除术或接受盆腔及腹主动脉旁淋巴结联合切除术。采用逆概率加权法进行Cox比例风险生存分析。风险比（HRs）经协变量和倾向评分调整。协变量包括癌症中心类型、年龄、种族、西班牙裔、保险类型、社区收入中位数四分位数、合并症评分、既往癌症史、肌层浸润深度、肿瘤分级、肿瘤大小、淋巴管间隙浸润、细胞学状态、手术切缘状态、医院规模以及辅助放疗或化疗的使用情况。额外的分析包括按分级进行亚组分析、对缺失数据进行插补的敏感性分析以及对可能未测量的混杂因素的敏感性检验。
结果
在未进行淋巴结切除术、盆腔淋巴结切除术以及盆腔及腹主动脉旁淋巴结联合切除术的匹配队列中，淋巴结计数的中位数（四分位间距[IQR]）分别为0、10（5 - 15）和20（15 - 27）个。匹配队列具有良好的平衡性。进行了两项分析：未进行淋巴结切除术（n = 7487）与盆腔淋巴结切除术（n = 7487），以及盆腔淋巴结切除术（n = 7060）与盆腔及腹主动脉旁淋巴结联合切除术（n = 7060）。与未进行淋巴结切除术相比，盆腔淋巴结切除术与生存率提高相关（5年生存率[95%CI]，91.4%[90.2%至92.6%]对87.3%[85.9%至88.8%]；HR，0.71[95%CI，0.64至0.78]；P <.001）。与单纯盆腔淋巴结切除术相比，增加腹主动脉旁淋巴结切除术与生存率提高相关（5年生存率[95%CI]，91.0%[89.8%至92.2%]对89.8%[88.4%至91.1%]；HR，0.85[95%CI，0.77至0.95]；P =.003）。这些关联在敏感性分析中具有稳健性。
结论
淋巴结切除术与I期子宫内膜样腺癌患者生存率的提高相关。需要进行一项有足够效力的随机试验。
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