Xu Jie, Chen Can, Xiong Jing, Linghu Hua
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China.
The First Clinical College, Chongqing Medical University, Chongqing 400016, People's Republic of China.
Cancer Manag Res. 2020 Nov 30;12:12269-12276. doi: 10.2147/CMAR.S280780. eCollection 2020.
To determine whether systemic lymphadenectomy exerts a similar effect on the survival of patients with either type I or type II endometrial cancer (EC).
In this retrospective study, 682 eligible patients diagnosed with EC were typed according to the pathological reports. The thoroughness of lymphadenectomy was evaluated by the lymph node number of which the cut-off value was determined by the receiver operator characteristic (ROC) curve and Youden index. The impact of thoroughness on the survival of both types was analyzed, respectively, by Kaplan Meier (K-M) method and further evaluated in subgroups with and without lymphatic metastasis. Independent prognostic factors of survival were selected by proportional hazard regression (Cox) model.
The cut-off level of lymph node number was 20. The differential impact of the lymph node number removed on survival was noted when patients with different types were analyzed separately. Among type II EC, those with >20 lymph nodes removed presented better overall survival (OS) than those with ≤20 (=0.002). The number of lymph nodes removed >20 was proved as an independent factor for improved OS in type II EC (HR=0.329,95% CI: 0.123-0.881, =0.0027). In the subgroup of type II with >20 lymph nodes resected, similar 5-year OS rates were observed in those with or without identified positive node (90.9% vs 92.9%, =0.965). Type I EC seemed unbeneficial from such a procedure.
Systemic lymphadenectomy could enhance the OS of type II EC other than type I.
确定系统性淋巴结清扫术对Ⅰ型或Ⅱ型子宫内膜癌（EC）患者的生存是否具有相似的影响。
在这项回顾性研究中，根据病理报告对682例确诊为EC的合格患者进行分型。通过淋巴结数量评估淋巴结清扫的彻底性，其临界值由受试者工作特征（ROC）曲线和尤登指数确定。分别采用Kaplan-Meier（K-M）法分析清扫彻底性对两种类型患者生存的影响，并在有或无淋巴转移的亚组中进一步评估。通过比例风险回归（Cox）模型选择生存的独立预后因素。
淋巴结数量的临界水平为20。分别分析不同类型患者时，发现切除的淋巴结数量对生存有不同影响。在Ⅱ型EC中，切除淋巴结>20个的患者总生存期（OS）优于切除淋巴结≤20个的患者（P=0.002）。切除淋巴结>20个被证明是Ⅱ型EC患者OS改善的独立因素（HR=0.329，95%CI：0.123-0.881，P=0.0027）。在切除淋巴结>20个的Ⅱ型亚组中，有无阳性淋巴结的患者5年OS率相似（90.9%对92.9%，P=0.965）。Ⅰ型EC似乎未从此类手术中获益。
系统性淋巴结清扫术可提高Ⅱ型而非Ⅰ型EC的OS。
