Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany.
Eur J Surg Oncol. 2022 Jun;48(6):1407-1413. doi: 10.1016/j.ejso.2022.02.018. Epub 2022 Feb 18.
To examine the trends, characteristics, and outcomes related to sentinel lymph node (SLN) biopsy for cervical cancer surgery.
This retrospective cohort study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Study population included patients with invasive cervical cancer (squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma) who underwent both hysterectomy and lymphadenectomy for T1 classification from 2003 to 2018. Exposure allocation was per surgical nodal evaluation type (SLN biopsy or lymphadenectomy). Main outcome measures were (i) trend of utilization and patient characteristics related to SLN biopsy assessed with multivariable analysis and (ii) overall survival associated with SLN biopsy assessed with propensity score inverse probability of treatment weighting. Sensitivity cohorts included uterine-preserving conservative surgeries.
A total of 12,966 patients met the inclusion criteria. Of those, 430 (3.3%) patients underwent SLN biopsy. The utilization of SLN biopsy increased significantly from 0.8% to 15.2% during the study period (P < 0.001). This association remained independent in multivariable analysis: 2011-2014 versus 2003-2010 adjusted-odds ratio 4.87, 95% confidence interval (CI) 3.29-7.23, and 2015-2018 versus 2003-2010 adjusted-odds ratio 20.6, 95%CI 14.6-29.2. In a propensity score weighted model, patients who had SLN biopsy had similar overall survival compared to those without SLN biopsy (3-year rates, 94.8% versus 94.2%, hazard ratio 0.95, 95%CI 0.64-1.41, P = 0.799). In sensitivity analysis, the increase in SLN biopsy was also observed in uterine-preserving surgeries (3.5% to 9.6% for trachelectomy, P = 0.043; and 2.5% to 19.5% in cervical excision, P < 0.001).
Landscape of surgical nodal evaluation is gradually shifting from lymphadenectomy to SLN biopsy in cervical cancer surgery.
探讨宫颈癌手术中前哨淋巴结（SLN）活检的趋势、特征和结局。
本回顾性队列研究查询了美国国家癌症研究所的监测、流行病学和最终结果计划。研究人群包括 2003 年至 2018 年间接受子宫切除术和淋巴结切除术的 T1 分类浸润性宫颈癌（鳞状细胞癌、腺癌和腺鳞癌）患者。暴露分配为根据手术淋巴结评估类型（SLN 活检或淋巴结切除术）。主要观察指标为：（i）通过多变量分析评估与 SLN 活检相关的利用趋势和患者特征；（ii）通过倾向评分逆概率治疗加权评估与 SLN 活检相关的总生存。敏感性队列包括保留子宫的保守性手术。
共纳入 12966 例患者。其中，430 例（3.3%）患者接受了 SLN 活检。SLN 活检的使用率从研究期间的 0.8%显著增加到 15.2%（P<0.001）。这种关联在多变量分析中仍然独立：2011-2014 年与 2003-2010 年校正比值比为 4.87，95%置信区间（CI）为 3.29-7.23，2015-2018 年与 2003-2010 年校正比值比为 20.6，95%CI 为 14.6-29.2。在倾向评分加权模型中，接受 SLN 活检的患者与未接受 SLN 活检的患者的总生存相似（3 年生存率分别为 94.8%和 94.2%，风险比为 0.95，95%CI 为 0.64-1.41，P=0.799）。在敏感性分析中，保留子宫的手术中 SLN 活检的使用率也有所增加（经宫颈广泛切除术为 3.5%至 9.6%，P=0.043；宫颈切除术为 2.5%至 19.5%，P<0.001）。
宫颈癌手术中手术淋巴结评估的格局正逐渐从淋巴结切除术向 SLN 活检转变。
