FIGO Ⅰ期子宫内膜样腺癌患者前哨淋巴结活检的结果。
Outcomes of sentinel lymph node mapping for patients with FIGO stage I endometrioid endometrial carcinoma.
机构信息
Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
出版信息
Gynecol Oncol. 2021 Jun;161(3):705-709. doi: 10.1016/j.ygyno.2021.03.018. Epub 2021 Mar 24.
OBJECTIVE
Investigate the overall survival of patients with FIGO stage I endometrioid endometrial carcinoma who underwent sentinel lymph node biopsy (SLNBx).
METHODS
Patients diagnosed between 2012 and 2015 with pathological stage I endometrioid endometrial carcinoma who underwent minimally invasive hysterectomy and had at least one month of follow-up were identified in the National Cancer Database (NCDB). Patients who underwent SLNBx or systematic lymphadenectomy (LND) (defined as at least 20 lymph nodes removed) were selected. Overall survival (OS) was evaluated following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to evaluate survival after controlling for confounders.
RESULTS
A total of 13,010 patients with endometrioid endometrial carcinoma who met the inclusion criteria were identified; 9861 (75.8%) and 3149 (24.2%) patients had systematic LND and SLNBx, respectively. Patients who had LND were more likely to receive radiation therapy (27.4% vs 19.3%, p < 0.001) and chemotherapy (13% vs 8.7%, p < 0.001) compared to those who had SLNBx. After controlling for patient age, race, insurance status, depth of myometrial invasion, tumor grade, tumor size, presence of lymph-vascular invasion and receipt of radiation therapy, the performance of SLNBx was not associated with worse survival (HR: 0.99, 95% CI: 0.80, 1.21). For high-intermediate risk patients (based on GOG-99 criteria) after controlling for confounders, performance of SLNBx was not associated with worse survival (HR: 1.07, 95% CI: 0.80, 1.44). For intermediate risk patients who did not receive external beam radiation therapy or chemotherapy after controlling for confounders, performance of SLNBx was not associated with worse survival (HR: 1.58, 95% CI: 0.94, 2.65).
CONCLUSIONS
SLNBx had no negative impact on the survival of patients with FIGO stage I endometrioid endometrial carcinoma who undergo hysterectomy.
目的
探讨接受前哨淋巴结活检（SLNBx）的国际妇产科联盟（FIGO）Ⅰ期子宫内膜样腺癌患者的总生存率。
方法
在国家癌症数据库（NCDB）中，确定了 2012 年至 2015 年间诊断为Ⅰ期子宫内膜样腺癌且接受微创手术性子宫切除术并至少随访一个月的患者。选择接受 SLNBx 或系统淋巴结清扫术（LND）（定义为至少切除 20 个淋巴结）的患者。生成 Kaplan-Meier 曲线并使用对数秩检验评估总生存率（OS）。构建 Cox 模型以在控制混杂因素后评估生存情况。
结果
共确定了 13010 例符合纳入标准的子宫内膜样腺癌患者；9861 例（75.8%）和 3149 例（24.2%）患者分别接受了系统 LND 和 SLNBx。与接受 SLNBx 的患者相比，接受 LND 的患者更有可能接受放疗（27.4% vs 19.3%，p<0.001）和化疗（13% vs 8.7%，p<0.001）。在控制患者年龄、种族、保险状况、肌层浸润深度、肿瘤分级、肿瘤大小、淋巴管血管侵犯存在和放疗后，SLNBx 的性能与较差的生存率无关（HR：0.99，95%CI：0.80，1.21）。对于基于 GOG-99 标准的高-中危患者，在控制混杂因素后，SLNBx 的性能与较差的生存率无关（HR：1.07，95%CI：0.80，1.44）。对于未接受外照射放疗或化疗的中危患者，在控制混杂因素后，SLNBx 的性能与较差的生存率无关（HR：1.58，95%CI：0.94，2.65）。
结论
SLNBx 对接受子宫切除术的 FIGO Ⅰ期子宫内膜样腺癌患者的生存没有负面影响。
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