Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
Gynecologic Oncology Unit, Metropolitan Hospital, Athen, Greece.
Arch Gynecol Obstet. 2020 Jul;302(1):231-239. doi: 10.1007/s00404-020-05600-8. Epub 2020 May 19.
The positive effect of systematic lymphadenectomy on survival of patients with endometrial cancer is a topic of ongoing debate.
We aimed to investigate whether systemic lymphadenectomy is beneficial for patients with early endometrial cancer. For this purpose, we analyzed a population-based registry with of 2392 women with endometrioid endometrial cancer, stage I and II at intermediate and high risk of recurrence. The primary outcome measure was overall survival.
After exclusions, 868 women were eligible for analysis. Of those, 511 and 357 were categorized as intermediate (pT1A G3 and pT1B G1-2) and high risk (pT1B G3 and pT2 G1-3) early stage endometrial cancer, respectively. Lymphadenectomy was performed in 527 (60.7%) of the cases. Patients in the lymphadenectomy group were significantly younger, presented with more tumors of intermediate or undifferentiated grade and exhibited significantly lower co-morbidity rates and Eastern Cooperative of Oncology Group (ECOG) performance status. Median follow-up was 6.7 years. Recurrence-free survival was not improved by lymphadenectomy in the intermediate and high-risk group of patients. During the follow-up period, 111 (12.8%) women had disease recurrence and 302 (34.8%) died. Systematic lymphadenectomy was associated with significant improvement of overall survival in the pT1A G3 and pT1B G3 patient subgroups. Notably, adjustment for patient age and ECOG status abolished the improvement of overall survival by systematic lymphadenectomy in all groups. Thus, lymphadenectomy did not improve recurrence-free survival in the intermediate risk or the high-risk group of patients CONCLUSIONS: Systematic pelvic and para-aortic lymphadenectomy did not improve the survival of patients with early stage I and II endometrioid endometrial cancer at intermediate and high risk of recurrence.
系统性淋巴结清扫术对子宫内膜癌患者生存的积极影响是一个持续存在的争议话题。
我们旨在研究系统性淋巴结清扫术是否对早期子宫内膜癌患者有益。为此，我们分析了一个基于人群的登记处，其中包括 2392 名患有子宫内膜样子宫内膜癌、Ⅰ期和Ⅱ期、复发风险中等和高的女性。主要观察指标是总生存。
排除后，868 名女性符合分析条件。其中，511 名和 357 名分别归类为中危（pT1A G3 和 pT1B G1-2）和高危（pT1B G3 和 pT2 G1-3）早期子宫内膜癌。527 例（60.7%）患者行淋巴结清扫术。淋巴结清扫术组患者明显更年轻，肿瘤中间级或未分化级别的比例更高，合并症发生率和东部肿瘤协作组（ECOG）表现状态明显更低。中位随访时间为 6.7 年。淋巴结清扫术并未改善中危和高危患者的无复发生存率。在随访期间，111 名（12.8%）女性出现疾病复发，302 名（34.8%）死亡。在 pT1A G3 和 pT1B G3 患者亚组中，系统性淋巴结清扫术与总生存率的显著改善相关。值得注意的是，调整患者年龄和 ECOG 状态后，所有组中系统性淋巴结清扫术对总生存率的改善均消失。因此，淋巴结清扫术并未改善中危和高危患者的无复发生存率。
系统性盆腔和腹主动脉旁淋巴结清扫术并未改善复发风险中等和高的早期Ⅰ期和Ⅱ期子宫内膜样子宫内膜癌患者的生存。
