Tian Yong, Ran Lin, Liu Yi, Xu Yu, Shen Juan, Mi Gong-Sheng, Ke Feng-Mei
Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China.
Department of Obstetrics and Gynecology, West China Second University Hospital, Chengdu, Sichuan University, Chengdu, China.
Front Oncol. 2022 Mar 24;12:800957. doi: 10.3389/fonc.2022.800957. eCollection 2022.
The survival value of systematic lymphadenectomy for endometrial cancer is ambiguous and controversial. The current study aimed to evaluate the long-term survival role of combined pelvic and para-aortic lymphadenectomy in patients with presumed early-stage clear cell carcinoma of the endometrium.
Patients in three Chinese teaching hospitals who presented between 2012 and 2017 with apparent early-stage clear cell carcinoma of the endometrium and underwent surgical staging were selected. Patients who did and did not undergo systematic lymphadenectomy were identified and clinicopathological characteristics were compared. Disease-free survival and overall survival were evaluated following the generation of the Kaplan-Meier curves and the comparison using the log-rank test. A Cox proportional hazards model was employed to control for confounders.
A total of 244 patients underwent systematic lymphadenectomy and 89 did not receive lymph node dissection. The demographic and baseline data were comparable between the two groups. The rate of disease-free survival at 5 years was 64.10% in patients who underwent systematic lymphadenectomy and 45.05% in patients who did not undergo lymphadenectomy. Patients who underwent systematic lymphadenectomy had better disease-free survival than those who did not receive lymphadenectomy (HR, 0.54. 95% CI, 0.38-0.76. =0.000). The rate of 5-year overall survival was 68.87% in the lymphadenectomy group and 53.33% in patients who did not undergo systematic lymphadenectomy. Systematic lymphadenectomy was also associated with improved 5-year overall survival for women with presumed early-stage clear cell carcinoma of the endometrium (HR, 0.58. 95% CI, 0.39-0.85. =0.005). After adjusting for confounders, systematic lymphadenectomy was still independently associated with improved disease-free survival and overall survival.
Patients with apparent early-stage clear cell carcinoma of the endometrium who underwent systematic lymphadenectomy had better long-term survival than those who did not undergo systematic lymphadenectomy.
子宫内膜癌系统性淋巴结清扫术的生存价值尚不明确且存在争议。本研究旨在评估盆腔和腹主动脉旁淋巴结联合清扫术对疑似早期子宫内膜透明细胞癌患者的长期生存作用。
选取2012年至2017年间在中国三家教学医院就诊、表现为疑似早期子宫内膜透明细胞癌且接受手术分期的患者。确定接受和未接受系统性淋巴结清扫术的患者，并比较其临床病理特征。绘制Kaplan-Meier曲线并使用对数秩检验进行比较后，评估无病生存期和总生存期。采用Cox比例风险模型控制混杂因素。
共有244例患者接受了系统性淋巴结清扫术，89例未接受淋巴结清扫。两组的人口统计学和基线数据具有可比性。接受系统性淋巴结清扫术的患者5年无病生存率为64.10%，未接受淋巴结清扫术的患者为45.05%。接受系统性淋巴结清扫术的患者无病生存期优于未接受淋巴结清扫术的患者（风险比，0.54。95%置信区间，0.38 - 0.76。P = 0.000）。淋巴结清扫术组的5年总生存率为68.87%，未接受系统性淋巴结清扫术的患者为53.33%。系统性淋巴结清扫术也与疑似早期子宫内膜透明细胞癌女性患者5年总生存期的改善相关（风险比，0.58。95%置信区间，0.39 - 0.85。P = 0.005）。在调整混杂因素后，系统性淋巴结清扫术仍与无病生存期和总生存期的改善独立相关。
接受系统性淋巴结清扫术的疑似早期子宫内膜透明细胞癌患者的长期生存率高于未接受系统性淋巴结清扫术的患者。
