Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine and Faculty of Medicine, Sapporo, Japan.
Department of Obstetrics and Gynecology, University of Tsukuba, Faculty of Medicine, Tsukuba, Japan.
J Gynecol Oncol. 2021 Mar;32(2):e25. doi: 10.3802/jgo.2021.32.e25. Epub 2021 Jan 7.
This review aims to introduce preoperative scoring systems to predict lymph node metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role of lymphadenectomy for endometrial cancer.
We summarized previous reports on the preoperative prediction models for LNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, we compared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) to examine the survival benefit of lymphadenectomy in endometrial cancer, and described the details of JCOG1412.
Lymphadenectomy has been omitted for 64 endometrial cancer patients who met low-risk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphatic failure has been observed. Other two models also produced comparable results. Two randomized phase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrial cancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aortic lymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients at risk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, including lower limit of the number of resected nodes, and submission of photos of dissected area to evaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showed that the quality of lymphadenectomy has been well-controlled in JCOG1412.
Our strategy seems reasonable to omit lymphadenectomy and could be generalized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms of the quality of surgical procedures, which would draw the bona-fide conclusions regarding the therapeutic role of lymphadenectomy for endometrial cancer.
本综述旨在介绍预测淋巴结转移（LNM）的术前评分系统和正在进行的临床试验，以探讨淋巴结切除术在子宫内膜癌中的治疗作用。
我们总结了先前关于 LNM 术前预测模型的报告，并评估了它们在我们最近的队列中省略淋巴结切除术的有效性。接下来，我们比较了两项正在进行的淋巴结切除术试验（JCOG1412、ECLAT）的特征，以检查淋巴结切除术在子宫内膜癌中的生存获益，并描述了 JCOG1412 的细节。
使用我们的评分系统（LNM 评分），有 64 名符合低危标准的子宫内膜癌患者省略了淋巴结切除术，且未发生淋巴漏。其他两种模型也产生了类似的结果。两项评估淋巴结切除术生存获益的随机 III 期临床试验正在进行中。JCOG1412 比较了单纯盆腔淋巴结切除术与盆腔和腹主动脉旁淋巴结切除术，以评估腹主动脉旁淋巴结切除术对有 LNM 风险的患者的治疗作用。为了保证淋巴结切除术的质量，我们在方案中定义了几个规定，包括切除淋巴结的下限数量，并提交解剖区域的照片，以评估淋巴结切除术的彻底性。最新的监测报告显示，JCOG1412 中淋巴结切除术的质量得到了很好的控制。
我们的策略似乎合理，可以省略淋巴结切除术，并在临床实践中推广。从手术程序的质量来看，JCOG1412 是一项高质量的淋巴结切除术试验，将得出关于淋巴结切除术治疗子宫内膜癌的真实结论。
