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.
Gynecol Oncol. 2022 May;165(2):361-368. doi: 10.1016/j.ygyno.2022.02.023. Epub 2022 Mar 7.
The current clinical practice guidelines for endometrial cancer specify sentinel lymph node (SLN) biopsy to be performed in apparent uterine-confined disease. However, a recent population-based analysis found that the utilization of SLN biopsy is increasing in extra-uterine disease such as T2 classification. The objective of this study was to examine trends and outcomes related to SLN biopsy for endometrial cancer with T3 classification, another extra-uterine disease.
A population-based retrospective cohort study was conducted to examine 7004 women with T3 endometrial cancer who underwent primary surgery between 2010 and 2018, identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Trends and characteristics related to SLN biopsy were assessed by multinomial regression analysis, and inverse probability of treatment weighting propensity score was used to assess overall survival related to SLN biopsy.
Nodal evaluation type included lymphadenectomy (n = 5276, 75.3%), SLN biopsy (n = 287, 4.1%), and none (n = 1441, 20.6%). The utilization of SLN biopsy increased from 0.4% to 12.9% between 2010 and 2018 (P < 0.001) that this association remained independent in multivariable analysis (adjusted-odds ratio compared to 2010-2012, 2.63 [95% confidence interval 1.57-4.42] for 2013-2015 and 10.1 [95% confidence interval 6.30-16.2] for 2016-2018). When compared to the lymphadenectomy group, the SLN biopsy group was less likely to have T3b disease (adjusted-odds ratio 0.69, 95% confidence interval 0.51-0.94) but had similar postoperative chemotherapy and radiotherapy (both, P > 0.05). In a weighted model, the 3-year overall survival rate was 66.3% for the SLN biopsy group and 64.7% for the lymphadenectomy group (hazard ratio 0.85, 95% confidence interval 0.69-1.05). Similar association was observed in subcohorts for young, old, endometrioid, non-endometrioid, T3a, T3b, and N0 cases.
Utilization of SLN biopsy in T3 endometrial cancer is increasing in the United States.
当前子宫内膜癌的临床实践指南规定，在明显局限于子宫的疾病中进行前哨淋巴结（SLN）活检。然而，最近的一项基于人群的分析发现，SLN 活检在 T2 分类等子宫外疾病中的应用正在增加。本研究的目的是检查 T3 分类（另一种子宫外疾病）的子宫内膜癌与 SLN 活检相关的趋势和结局。
对国家癌症研究所的监测、流行病学和最终结果计划中 2010 年至 2018 年间接受初次手术的 7004 名 T3 子宫内膜癌女性进行了一项基于人群的回顾性队列研究。通过多项回归分析评估与 SLN 活检相关的趋势和特征，并使用逆概率治疗加权倾向评分来评估与 SLN 活检相关的总生存率。
淋巴结评估类型包括淋巴结切除术（n=5276，75.3%）、SLN 活检（n=287，4.1%）和无淋巴结评估（n=1441，20.6%）。2010 年至 2018 年间，SLN 活检的使用率从 0.4%增加到 12.9%（P<0.001），多变量分析显示这种关联仍然独立（与 2010-2012 年相比，调整后的优势比为 2.63[95%置信区间为 1.57-4.42]，2013-2015 年为 2.63[95%置信区间为 1.57-4.42]，2016-2018 年为 10.1[95%置信区间为 6.30-16.2]）。与淋巴结切除术组相比，SLN 活检组 T3b 疾病的可能性较小（调整后的优势比为 0.69，95%置信区间为 0.51-0.94），但术后化疗和放疗相似（均 P>0.05）。在加权模型中，SLN 活检组的 3 年总生存率为 66.3%，淋巴结切除术组为 64.7%（风险比为 0.85，95%置信区间为 0.69-1.05）。在年轻、年老、子宫内膜样、非子宫内膜样、T3a、T3b 和 N0 病例的亚组中也观察到了类似的关联。
在美国，T3 子宫内膜癌中 SLN 活检的应用正在增加。
