Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy.
Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy.
Gynecol Oncol. 2019 Jun;153(3):676-683. doi: 10.1016/j.ygyno.2019.03.254. Epub 2019 Apr 2.
Sentinel node mapping is increasingly being utilized for endometrial cancer staging. However, only limited evidence supporting the adoption of sentinel node mapping instead of conventional lymphadenectomy is still available. Here, we aimed to review the current evidence comparing sentinel node mapping and lymphadenectomy in endometrial cancer staging. This systematic review was registered in the International Prospective Register of Systematic Reviews. Six comparative studies were included. Overall, 3536 patients were included: 1249 (35.3%) and 2287 (64.7%), undergoing sentinel node mapping and lymphadenectomy, respectively. Pooled data suggested that positive pelvic nodes were detected in 184 out of 1249 (14.7%) patients having sentinel node mapping and 228 out of 2287 (9.9%) patients having lymphadenectomy (OR: 2.03; (95%CI: 1.30 to 3.18); p = 0.002). No difference in detection of positive nodes located in the paraaortic was observed (OR: 93 (95%CI: 0.39 to 2.18); p = 0.86). Overall recurrence rate was 4.3% and 7.3% after sentinel node mapping and lymphadenectomy, respectively (OR: 0.90 (95%CI: 0.58 to 1.38); p = 0.63). Similarly, nodal recurrences were statistically similar between groups (1.2% vs. 1.7%; OR: 1.51 (95%CI: 0.70 to 3.29); p = 0.29). In conclusion, our meta-analysis underlines that sentinel node mapping is non-inferior to standard lymphadenectomy in term of detection of paraaortic nodal involvement and recurrence rates (any site and nodal recurrence); while, focusing on the ability to detect positive pelvic nodes, sentinel node mapping could be consider superior to lymphadenectomy. Further randomized studies are needed to asses long term effectiveness of sentinel node mapping.
前哨淋巴结绘图越来越多地用于子宫内膜癌分期。然而，目前仍然只有有限的证据支持采用前哨淋巴结绘图来替代传统的淋巴结切除术。在这里，我们旨在回顾比较前哨淋巴结绘图和淋巴结切除术在子宫内膜癌分期中的当前证据。这项系统综述已在国际前瞻性系统评价注册中心注册。共纳入了 6 项比较研究。共有 3536 名患者入组：1249 名（35.3%）和 2287 名（64.7%）分别接受了前哨淋巴结绘图和淋巴结切除术。汇总数据表明，在接受前哨淋巴结绘图的 1249 名患者中有 184 名（14.7%）和接受淋巴结切除术的 2287 名患者中有 228 名（9.9%）检测到盆腔淋巴结阳性（OR：2.03；95%CI：1.30 至 3.18；p=0.002）。在前哨淋巴结绘图和淋巴结切除术组中，未观察到检测到阳性淋巴结位于腹主动脉旁的差异（OR：93（95%CI：0.39 至 2.18）；p=0.86）。前哨淋巴结绘图和淋巴结切除术的总复发率分别为 4.3%和 7.3%（OR：0.90（95%CI：0.58 至 1.38）；p=0.63）。同样，淋巴结复发在组间统计学上无差异（1.2%比 1.7%；OR：1.51（95%CI：0.70 至 3.29）；p=0.29）。总之，我们的荟萃分析强调，在前哨淋巴结绘图在检测腹主动脉旁淋巴结受累和复发率（任何部位和淋巴结复发）方面与标准淋巴结切除术相当；而在前哨淋巴结绘图检测盆腔阳性淋巴结方面，可能优于淋巴结切除术。需要进一步的随机研究来评估前哨淋巴结绘图的长期效果。
