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 Jul;31(7):1001-1006. doi: 10.1136/ijgc-2021-002445. Epub 2021 Apr 14.
To investigate the prevalence of positive peritoneal cytology and lymph-vascular invasion by surgical approach among patients with early stage endometrioid endometrial carcinoma undergoing hysterectomy.
The National Cancer Database was accessed and patients with FIGO stage I endometrioid endometrial carcinoma (with no history of another tumor diagnosed) who underwent simple hysterectomy (open or minimally invasive) between January 2010 and December 2015 and had available data on the presence of lymph-vascular invasion and/or status of peritoneal cytology were selected for further analysis. The impact of a surgical approach on the odds of lymph-vascular invasion and positive peritoneal cytology was calculated after controlling for tumor grade, size, and depth of myometrial invasion.
A total of 74 732 patients who met the inclusion criteria were identified. The rate of minimally invasive hysterectomy was 75.7%. Data on peritoneal cytology status and lymph-vascular invasion were available for 50 185 and 71 641 patients, respectively. A higher proportion of patients who had minimally invasive hysterectomy had positive peritoneal cytology (4.4% vs 2.3%, p<0.001), and presence of lymph-vascular invasion (10.4% vs 9.2%, p<0.001). After controlling for tumor size, tumor grade, and disease substage, the performance of minimally invasive surgery was associated with higher odds of positive peritoneal cytology (OR 2.08, 95% CI 1.83 to 2.37) and presence of lymph-vascular invasion (OR 1.33, 95% CI 1.25 to 1.41). After controlling for confounders there was no difference in survival between open and minimally invasive surgery groups (HR 0.93, 95% CI 0.85 to 1.004).
Minimally invasive surgery may be associated with a higher incidence of positive peritoneal cytology and lymph-vascular invasion among patients with early stage endometrioid endometrial cancer. There was no difference in overall survival between patients who had laparotomy or minimally invasive surgery.
通过手术方法研究行子宫切除术的早期子宫内膜样型子宫内膜癌患者腹膜细胞学阳性和淋巴管血管侵犯的发生率。
访问国家癌症数据库，选择 2010 年 1 月至 2015 年 12 月期间接受单纯子宫切除术（开放式或微创式）且FIGO 分期为 I 期子宫内膜样型子宫内膜癌（无另一种肿瘤诊断史）且具有淋巴管血管侵犯和/或腹膜细胞学状态的患者数据进行进一步分析。控制肿瘤分级、大小和肌层浸润深度后，计算手术方法对淋巴管血管侵犯和腹膜细胞学阳性的可能性的影响。
确定了符合纳入标准的共 74732 名患者。微创子宫切除术的比例为 75.7%。50185 名患者的腹膜细胞学状态和 71641 名患者的淋巴管血管侵犯数据可用。微创性子宫切除术的患者腹膜细胞学阳性的比例（4.4%对 2.3%，p<0.001）和存在淋巴管血管侵犯的比例（10.4%对 9.2%，p<0.001）更高。控制肿瘤大小、肿瘤分级和疾病亚分期后，微创手术的表现与腹膜细胞学阳性（OR 2.08，95%CI 1.83 至 2.37）和淋巴管血管侵犯（OR 1.33，95%CI 1.25 至 1.41）的可能性更高相关。控制混杂因素后，剖腹手术组和微创手术组之间的生存无差异（HR 0.93，95%CI 0.85 至 1.004）。
微创性手术可能与早期子宫内膜样型子宫内膜癌患者腹膜细胞学阳性和淋巴管血管侵犯的发生率较高相关。腹腔镜手术组和微创手术组的总生存率无差异。
