Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
Gynecol Oncol. 2020 Jan;156(1):70-76. doi: 10.1016/j.ygyno.2019.10.005. Epub 2019 Nov 16.
The objective of our study was to assess survival among patients with uterine serous carcinoma (USC) undergoing sentinel lymph node (SLN) mapping alone versus patients undergoing systematic lymphadenectomy (LND).
We retrospectively reviewed patients undergoing primary surgical treatment for newly diagnosed USC at our institution from 1/1/1996-12/31/2017. Patients were assigned to either SLN mapping alone (SLN cohort) or systematic LND without SLN mapping (LND cohort). Progression-free (PFS) and overall survival (OS) were estimated using Kaplan-Meier method, compared using Logrank test.
245 patients were available for analysis: 79 (32.2%) underwent SLN, 166 (67.7%) LND. 132 (79.5%) in the LND cohort had paraaortic LND (PALND) versus none in the SLN cohort. Median age: 66 and 68 years in the SLN and LND cohorts, respectively (p>0.05). Proportion of stage I/II disease: 67.1% (n = 53) and 64.5% (n = 107) in the SLN and LND cohorts, respectively (p>0.05). Median follow-up: 23 (range, 1-96) and 66 months (range, 4-265) in the SLN and LND cohorts, respectively (p < 0.001). Two-year OS in stage I/II disease (n = 160, 60.1%): 96.6% (SE ± 3.4) and 89.6% (SE ± 2.2) in the SLN and LND cohorts, respectively (p = 0.8). Two-year OS in stage III disease (n = 77): 73.6% (SE ± 10.2) and 77.3% (SE ± 5.8) in the SLN and LND cohorts, respectively (p = 0.8).
SLN mapping alone and systematic LND yielded similar survival outcomes in stage I-III USC. In our practice, the SLN algorithm has replaced systematic LND as the primary staging modality in this setting.
本研究旨在评估单独行前哨淋巴结（SLN）检测与系统行淋巴结清扫术（LND）在子宫浆液性癌（USC）患者中的生存情况。
我们回顾性分析了 1996 年 1 月 1 日至 2017 年 12 月 31 日期间在我院接受新诊断的 USC 初次手术治疗的患者。将患者分为仅行 SLN 检测（SLN 组）或不进行 SLN 检测而行系统 LND（LND 组）。采用 Kaplan-Meier 法估计无进展生存期（PFS）和总生存期（OS），并采用 Logrank 检验进行比较。
共纳入 245 例患者进行分析：79 例行 SLN，166 例行 LND。LND 组中 132 例行腹主动脉旁淋巴结清扫术（PALND），而 SLN 组中无患者行此术式。LND 组和 SLN 组的中位年龄分别为 66 岁和 68 岁（p>0.05）。Ⅰ/Ⅱ期疾病的比例分别为 67.1%（n=53）和 64.5%（n=107）（p>0.05）。SLN 组和 LND 组的中位随访时间分别为 23 个月（范围，1-96）和 66 个月（范围，4-265）（p<0.001）。Ⅰ/Ⅱ期疾病患者的 2 年 OS（n=160，60.1%）：SLN 组和 LND 组分别为 96.6%（SE±3.4）和 89.6%（SE±2.2）（p=0.8）。Ⅲ期疾病患者的 2 年 OS（n=77）：SLN 组和 LND 组分别为 73.6%（SE±10.2）和 77.3%（SE±5.8）（p=0.8）。
在Ⅰ-Ⅲ期 USC 患者中，单独行 SLN 检测和系统行 LND 可获得相似的生存结果。在我们的实践中，SLN 算法已取代系统 LND 成为该治疗策略的主要分期方式。
