Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Int J Gynecol Cancer. 2021 Jun;31(6):840-845. doi: 10.1136/ijgc-2021-002450. Epub 2021 Apr 14.
To investigate the survival of patients with lymph node positive endometrial carcinoma by type of surgical lymph node assessment.
Patients diagnosed between January 2012 and December 2015 with endometrial carcinoma and uterine confined disease and nodal metastases on final pathology who underwent minimally invasive hysterectomy were identified in the National Cancer Database. Patients who had sentinel lymph node biopsy alone or underwent systematic lymphadenectomy were selected. Overall survival 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.
A total of 1432 patients were identified: 1323 (92.4%) and 109 (7.6%) underwent systematic lymphadenectomy and sentinel lymph node biopsy only, respectively. The rate of adjuvant treatment was comparable between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (83.5% vs 86.6%, p=0.39). However, patients who had sentinel lymph node biopsy were less likely to receive chemotherapy alone (13.6% vs 36.6%, p<0.001) and more likely to receive radiation therapy alone (19.8% vs 5.4%, p<0.001) compared with patients who had systematic lymphadenectomy. There was no difference in overall survival between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (p=0.27 from log rank test), and 3 year overall survival rates were 82.2% and 79.4%, respectively (p>0.05). After controlling for confounders, there was no difference in survival between the systematic lymphadenectomy and sentinel lymph node biopsy alone groups (hazard ratio 0.82, 95% confidence interval 0.46 to 1.45).
Performance of sentinel lymph node biopsy alone was not associated with an adverse impact on survival in patients with lymph node positive endometrial cancer.
通过淋巴结评估类型，研究淋巴结阳性子宫内膜癌患者的生存率。
在国家癌症数据库中，确定了 2012 年 1 月至 2015 年 12 月期间诊断为子宫内膜癌和子宫局限性疾病且最终病理有淋巴结转移并接受微创手术的患者。选择仅行前哨淋巴结活检或系统淋巴结清扫术的患者。生成 Kaplan-Meier 曲线评估总生存率，并通过对数秩检验进行比较。构建 Cox 模型，在控制混杂因素后评估生存情况。
共纳入 1432 例患者：1323 例（92.4%）和 109 例（7.6%）分别行系统淋巴结清扫术和前哨淋巴结活检术。单独行前哨淋巴结活检术和系统淋巴结清扫术的患者辅助治疗率相似（83.5%比 86.6%，p=0.39）。然而，与行系统淋巴结清扫术的患者相比，单独行前哨淋巴结活检术的患者接受单独化疗的可能性较小（13.6%比 36.6%，p<0.001），接受单独放疗的可能性较大（19.8%比 5.4%，p<0.001）。单独行前哨淋巴结活检术与系统淋巴结清扫术患者的总生存率无差异（对数秩检验 p=0.27），3 年总生存率分别为 82.2%和 79.4%（p>0.05）。在控制混杂因素后，系统淋巴结清扫术与单独行前哨淋巴结活检术患者的生存情况无差异（风险比 0.82，95%置信区间 0.46 至 1.45）。
对于淋巴结阳性子宫内膜癌患者，单独行前哨淋巴结活检术不会对生存产生不利影响。
