Garzon Simone, Mariani Andrea, Day Courtney N, Habermann Elizabeth B, Langstraat Carrie, Glaser Gretchen, Kumar Amanika, Casarin Jvan, Uccella Stefano, Ghezzi Fabio, Larish Alyssa
Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy.
Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
Int J Gynecol Cancer. 2022 Jan;32(1):28-40. doi: 10.1136/ijgc-2021-002927. Epub 2021 Nov 8.
Substituting lymphadenectomy with sentinel lymph node biopsy for staging purposes in endometrial cancer has raised concerns about incomplete nodal resection and detrimental oncological outcomes. Therefore, this study aimed to investigate the association between the type of lymph node assessment and overall survival in endometrial cancer accounting for node status and histology.
Women with stage I-III endometrial cancer who underwent hysterectomy and lymph node assessment from January 2012 to December 2015 were identified in the National Cancer Database. Patients who underwent neoadjuvant therapy, had previous cancer, and whose follow-up was less than 90 days were excluded. Multivariable Cox proportional hazards regression analyses were performed to assess factors associated with overall survival.
Of 68 614 patients, 64 796 (94.4%) underwent lymphadenectomy, 1777 (2.6%) underwent sentinel node biopsy only, and 2041 (3.0%) underwent both procedures. On multivariable analysis, neither sentinel lymph node biopsy alone nor sentinel node biopsy followed by lymphadenectomy was associated with significantly different overall survival compared with lymphadenectomy alone (HR 0.92, 95% CI 0.73 to 1.17, and HR 0.91, 95% CI 0.77 to 1.08, respectively). When stratified by lymph node status, sentinel node biopsy alone or followed by lymphadenectomy was not associated with different overall survival, both in patients with negative (HR 0.95, 95% CI 0.73 to 1.24, and HR 1.04, 95% CI 0.85 to 1.27, respectively) or positive (HR 0.91, 95% CI 0.54 to 1.52, and HR 0.77, 95% CI 0.57 to 1.04, respectively) lymph nodes. These findings held true when sentinel node biopsy alone and sentinel node biopsy plus lymphadenectomy groups were merged, and on stratification by histotype (type one vs type 2) or inclusion of only complete lymphadenectomy (at least 10 pelvic nodes and at least one para-aortic node removed). In all analyses, age, Charlson-Deyo score, black race, AJCC pathological T stage, grade, lymphovascular invasion, brachytherapy, and adjuvant chemotherapy were independently associated with overall survival.
No difference in overall survival was found in patients with endometrial cancer who underwent sentinel node biopsy alone, sentinel node biopsy followed by lymphadenectomy, or lymphadenectomy alone. This observation remained regardless of node status, histotype, and lymphadenectomy extent.
用前哨淋巴结活检替代淋巴结清扫术用于子宫内膜癌分期引发了对淋巴结切除不完全及不良肿瘤学结局的担忧。因此，本研究旨在探讨淋巴结评估类型与子宫内膜癌总生存之间的关联，并考虑淋巴结状态和组织学类型。
在国家癌症数据库中识别出2012年1月至2015年12月期间接受子宫切除术和淋巴结评估的I-III期子宫内膜癌女性患者。排除接受新辅助治疗、既往有癌症且随访时间少于90天的患者。进行多变量Cox比例风险回归分析以评估与总生存相关的因素。
68614例患者中，64796例（94.4%）接受了淋巴结清扫术，1777例（2.6%）仅接受了前哨淋巴结活检，2041例（3.0%）接受了两种手术。多变量分析显示，与单纯淋巴结清扫术相比，单独前哨淋巴结活检或前哨淋巴结活检后行淋巴结清扫术的总生存均无显著差异（风险比分别为0.92，95%置信区间0.73至1.17；0.91，95%置信区间0.77至1.08）。按淋巴结状态分层时，无论淋巴结阴性（风险比分别为0.95，95%置信区间0.73至1.24；1.04，95%置信区间0.85至1.27）还是阳性（风险比分别为0.91，95%置信区间0.54至1.52；0.77，95%置信区间0.57至1.04），单独前哨淋巴结活检或前哨淋巴结活检后行淋巴结清扫术的总生存均无差异。当将单独前哨淋巴结活检组和前哨淋巴结活检加淋巴结清扫术组合并，并按组织学类型（1型与2型）分层或仅纳入完整淋巴结清扫术（至少切除10个盆腔淋巴结和至少1个腹主动脉旁淋巴结）时，这些结果依然成立。在所有分析中，年龄、Charlson-Deyo评分、黑人种族、美国癌症联合委员会（AJCC）病理T分期、分级、淋巴血管浸润、近距离放疗和辅助化疗均与总生存独立相关。
单独接受前哨淋巴结活检、前哨淋巴结活检后行淋巴结清扫术或单独行淋巴结清扫术的子宫内膜癌患者的总生存无差异。无论淋巴结状态、组织学类型和淋巴结清扫范围如何，这一观察结果均成立。
