Candido Elaine C, Rangel Neto Osmar F, Toledo Maria Carolina S, Torres José Carlos C, Cairo Aurea A A, Braganca Joana F, Teixeira Julio C
Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil.
Department of Obstetrics and Gynecology, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, s/n - Jd. Ipaussurama, Campinas, SP, 13060-904 Brazil.
Eur J Obstet Gynecol Reprod Biol X. 2019 Apr 18;3:100020. doi: 10.1016/j.eurox.2019.100020. eCollection 2019 Jul.
To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival.
194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression.
SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88-22.39; p = 0.003) associated with less DFS.
SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.
评估系统性淋巴结清扫术（SL）在I期子宫内膜样腺癌（EEC）处于复发、无病生存期（DFS）和生存率的中度风险（国际妇产科联盟（FIGO）IAG2/G3、IBG1/G2）患者中的适应证及效果。
评估1990年至2014年间194例行开腹子宫切除术的女性，其中95例行SL，99例未行SL。分析诊断时间、年龄、体重指数（BMI）、合并症、分期及辅助放疗情况。采用Kaplan-Meier法和对数秩检验分析DFS及癌症特异性生存率，采用Cox回归分析复发情况。
1998年前接受治疗的女性中93%（41/44）行SL，之后比例下降（p<0.001）。BMI低于35.0kg/m的女性（p<0.001）及无合并症的女性（p=0.017）行SL更频繁。两组间年龄、分期及术后放疗分布无差异。共14例复发（7.4%），集中在SL组（12例），且与IAG3期相关（35.7%，p=0.009）。纵向评估显示，非SL组5年癌症特异性生存率为95%，SL组为88%（p=0.039）；DFS率非SL组为97%，SL组为85%（p=0.004）。Cox回归分析显示IAG3期（风险比[HR]6.48，95%置信区间[IC95%]1.88 - 22.39；p=0.003）与DFS降低相关。
与未接受完整手术分期的患者相比，中度风险EEC手术分期中的SL在复发、DFS及癌症特异性生存率方面无益处。无论治疗方式如何，IAG3期预后均较差。我们的结果为支持当前在特定女性手术中避免SL的趋势提供了进一步证据。
