Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; the Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany; the Section of Urology, University of Chicago Medicine, Chicago, Illinois; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
Obstet Gynecol. 2022 May 1;139(5):809-820. doi: 10.1097/AOG.0000000000004733. Epub 2022 Apr 5.
To examine trends, characteristics, and oncologic outcomes of sentinel lymph node biopsy for early endometrial cancer.
This observational study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program by examining 83,139 women with endometrial cancer who underwent primary hysterectomy with nodal evaluation for T1 disease from 2003 to 2018. Primary outcome measures were the temporal trends in utilization of sentinel lymph node biopsy and patient characteristics associated with sentinel lymph node biopsy use, assessed by multivariable binary logistic regression models. Secondary outcome measure was endometrial cancer-specific mortality associated with sentinel lymph node biopsy, assessed by propensity score inverse probability of treatment weighting.
The utilization of sentinel lymph node biopsy increased from 0.2 to 29.7% from 2005 to 2018 (P<.001). The uptake was higher for women with endometrioid (0.3-31.6% between 2005 and 2018) compared with nonendometrioid (0.6-21.0% between 2006 and 2018) histologic subtypes (both P<.001). In a multivariable analysis, more recent year surgery, endometrioid histology, well-differentiated tumors, T1a disease, and smaller tumor size were independently associated with sentinel lymph node biopsy use (P<.05). Performance of sentinel lymph node biopsy was not associated with increased endometrial cancer-specific mortality compared with lymphadenectomy for endometrioid tumors (subdistribution hazard ratio [HR] 0.96, 95% CI 0.82-1.13) or nonendometrioid tumors (subdistribution HR 0.85, 95% CI 0.69-1.04). For low-risk endometrial cancer, the increase in sentinel lymph node biopsy resulted in a 15.3 percentage-point (1.4-fold) increase in surgical nodal evaluation by 2018 (expected vs observed rates, 37.8 vs 53.1%).
The landscape of surgical nodal evaluation is shifting from lymphadenectomy to sentinel lymph node biopsy for early endometrial cancer in the United States, with no indication of a negative effect on cancer-specific survival.
研究早期子宫内膜癌前哨淋巴结活检的趋势、特征和肿瘤学结果。
本观察性研究通过查询国家癌症研究所的监测、流行病学和最终结果计划，对 2003 年至 2018 年间 83139 例接受原发性子宫切除术和淋巴结评估的 T1 期子宫内膜癌女性进行了研究。主要观察指标是前哨淋巴结活检的应用趋势和与前哨淋巴结活检应用相关的患者特征，通过多变量二项逻辑回归模型进行评估。次要观察指标是前哨淋巴结活检与子宫内膜癌特异性死亡率的相关性，通过倾向评分逆概率治疗加权进行评估。
2005 年至 2018 年间，前哨淋巴结活检的使用率从 0.2%增加到 29.7%（P<.001）。与非子宫内膜样组织学类型（2006 年至 2018 年为 0.6%至 21.0%）相比，子宫内膜样组织学类型（2005 年至 2018 年为 0.3%至 31.6%）的使用率更高（均 P<.001）。多变量分析显示，较新的手术年份、子宫内膜样组织学、分化良好的肿瘤、T1a 疾病和较小的肿瘤大小与前哨淋巴结活检的应用独立相关（P<.05）。与淋巴结切除术相比，前哨淋巴结活检在子宫内膜样肿瘤（亚分布危险比[HR]0.96，95%置信区间[CI]0.82-1.13）或非子宫内膜样肿瘤（亚分布 HR 0.85，95% CI 0.69-1.04）中并未导致子宫内膜癌特异性死亡率的增加。对于低危子宫内膜癌，2018 年前哨淋巴结活检的增加导致手术淋巴结评估的比例增加了 15.3 个百分点（从 37.8%增加到 53.1%）（预期与观察率）。
在美国，早期子宫内膜癌的手术淋巴结评估正从淋巴结切除术向前哨淋巴结活检转变，且并未表明这对癌症特异性生存率有负面影响。
