Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Obstet Gynaecol Res. 2020 Apr;46(4):654-662. doi: 10.1111/jog.14198. Epub 2020 Feb 5.
The aim of our study was to investigate the lymph node metastasis (LNM) rate and effect of lymph node dissection (LND) in patients with stage I, low-grade endometrial stromal sarcoma (LGESS).
Patients with stage I LGESS (n = 119) that underwent surgery from July 1969 to July 2017, following up over 48 years at the China National Cancer Center were retrospectively analyzed in this study.
Surgical records and consulting data for patients with LGESS were analyzed to find that 47 patients received systematic pelvic LND. The number of patients with menopause in the LND(+) group were significantly lower than those in LND(-) group (2.1% vs 22.2%, P = 0.005), meanwhile, patients received bilateral salpingo-oophorectomy procedure in LND(+) group were significantly higher than LND(-) (97.9% vs 58.3%, P < 0.001). Neither progression-free survival nor overall survival was significantly improved in the LND(+) group even after propensity score matching although the progression-free survival has a stronger trend in LND(+) population.
A systematic LND was not significantly associated with prognosis for patients with early-stage LGESS. There is no sufficient indication for a systematic LND for patients with early-stage LGESS. A systematic LND might be necessary if enlarged lymph nodes were detected by image graphology or observation during surgery.
本研究旨在探讨Ⅰ期低级别子宫内膜间质肉瘤（LGESS）患者的淋巴结转移（LNM）率和淋巴结清扫（LND）的效果。
回顾性分析 1969 年 7 月至 2017 年 7 月在中国国家癌症中心接受手术治疗、随访时间超过 48 年的 119 例Ⅰ期 LGESS 患者的临床资料。
分析 LGESS 患者的手术记录和会诊资料发现，47 例患者接受了系统的盆腔 LND。LND(+)组的绝经患者比例明显低于 LND(-)组（2.1%比 22.2%，P=0.005），同时 LND(+)组接受双侧输卵管卵巢切除术的患者比例明显高于 LND(-)组（97.9%比 58.3%，P<0.001）。尽管 LND(+)人群的无进展生存率有更强的趋势，但即使在倾向评分匹配后，LND(+)组的无进展生存率和总生存率也没有显著提高。
系统 LND 与早期 LGESS 患者的预后无显著相关性。对于早期 LGESS 患者，系统 LND 没有充分的适应证。如果影像学或术中发现淋巴结肿大，则需要进行系统 LND。
