Cianci Stefano, Rosati Andrea, Vargiu Virginia, Capozzi Vito Andrea, Sozzi Giulio, Gioè Alessandro, Gueli Alletti Salvatore, Ercoli Alfredo, Cosentino Francesco, Berretta Roberto, Chiantera Vito, Scambia Giovanni, Fanfani Francesco
Department of Gynecologic Oncology and Minimally-invasive Gynecologic Surgery, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy.
Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Front Oncol. 2021 Oct 19;11:737096. doi: 10.3389/fonc.2021.737096. eCollection 2021.
The incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping.
A multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (<65 years old) and Group 2 (≥65 years old). The primary endpoint was the assessment of the overall, bilateral, and unsuccessful SLN mapping in the two groups. Secondary outcomes were the evaluation of SLN anatomical distribution and the identification of predictors for mapping failure applying a logistic regression.
A total of 844 patients were enrolled in the study (499 in Group 1 and 395 in Group 2). The overall detection rate, the successful bilateral mapping, and the mapping failure rate of the SLN were 93.8% . 87.6% ( = 0.002), 77.1% . 66.8% ( = 0.001), and 22.9% . 33.2% ( = 0.001), respectively, in Group 1 . Group 2. The advanced age affects the anatomical distribution of the SLN leading to a stepwise reduction of "unexpected" mapping sites (left hemipelvis: < 0.001; right hemipelvis: = 0.058). At multivariate analysis age ≥ 65 (OR: 1.495, 95% CI: 1.095-2.042, = 0.011), BMI (OR: 1.023, 95% CI: 1.000-1.046, = 0.047), non-endometrioid histotype (OR: 1.619, 95% CI: 1.067-2.458, = 0.024), and LVSI (OR: 1.407, 95% CI: 1.010-1.961, = 0.044) represent independent predictors of unsuccessful mapping. Applying binomial logistic regression analysis, there was a 1.280-fold increase in the risk of failed mapping for every 10-year-old increase in age (OR: 1.280, 95% CI: 1.108-1.479, = 0.001). A higher rate of surgical under-staging (0.9% . 3.3%, = 0.012) and adjuvant undertreatment ( = 0.018) was reported in Group 2.
Old age represents a risk factor for SLN mapping failure both intrinsically and in relation to the greater incidence of other independent risk factors such as LVSI, non-endometrioid histotype, and BMI. Surgeons should target the usual uptake along UPP during the SLN dissection in this subgroup of patients to minimize mapping failure and the consequent risk of surgical under-staging and adjuvant undertreatment.
子宫内膜癌在老年人中的发病率呈上升趋势。鉴于衰老会逐渐影响淋巴引流功能，我们旨在确定其对前哨淋巴结（SLN）定位期间IGC摄取的影响。
2015年5月至2021年3月期间，在四个癌症转诊中心确定了一个多中心回顾性队列，该队列中的子宫内膜癌患者表面上处于早期子宫内膜癌阶段，接受了完整的手术分期及SLN清扫。患者被分为第1组（<65岁）和第2组（≥65岁）。主要终点是评估两组中SLN定位的总体、双侧及不成功情况。次要结果是评估SLN的解剖分布，并通过逻辑回归确定定位失败的预测因素。
共有844例患者纳入研究（第1组499例，第2组395例）。第1组和第2组中，SLN的总体检出率、双侧成功定位率及定位失败率分别为93.8%、87.6%（P = 0.002）、77.1%、66.8%（P = 0.001）和22.9%、33.2%（P = 0.001）。高龄影响SLN的解剖分布，导致“意外”定位部位逐步减少（左半骨盆：P < 0.001；右半骨盆：P = 0.058）。多因素分析显示，年龄≥65岁（比值比：1.495，95%置信区间：1.095 - 2.042，P = 0.011）、体重指数（比值比：1.023，95%置信区间：1.000 - 1.046，P = 0.047）、非子宫内膜样组织学类型（比值比：1.619，95%置信区间：1.067 - 2.458，P = 0.024）和淋巴血管间隙浸润（比值比：1.407，95%置信区间：1.010 - 1.961，P = 0.044）是定位不成功的独立预测因素。应用二项逻辑回归分析，年龄每增加10岁，定位失败风险增加1.280倍（比值比：1.280，95%置信区间：1.108 - 1.479，P = 0.001）。第2组报告的手术分期不足率（0.9%、3.3%，P = 0.012）和辅助治疗不足率（P = 0.018）更高。
高龄是SLN定位失败的一个危险因素，这既是内在因素，也与淋巴血管间隙浸润、非子宫内膜样组织学类型和体重指数等其他独立危险因素的较高发生率有关。在该亚组患者的SLN清扫过程中，外科医生应针对子宫旁组织的常见摄取部位，以尽量减少定位失败以及随之而来的手术分期不足和辅助治疗不足的风险。
