Matsuo Koji, Klar Maximilian, Barakzai Syem K, Jooya Neda D, Nusbaum David J, Shimada Muneaki, Roman Lynda D, Wright Jason D
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90033, USA.
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Arch Gynecol Obstet. 2023 Feb;307(2):525-532. doi: 10.1007/s00404-022-06595-0. Epub 2022 May 20.
Sentinel lymph node (SLN) biopsy has been incorporated into surgical care for many malignancies; however, the utility has not been examined in ovarian cancer. This study examined population-level trends, characteristics, and outcomes related to SLN biopsy in early stage ovarian cancer.
This is a retrospective cohort study querying the National Cancer Institute's Surveillance, Epidemiology, and End Result Program from 2003-2018. The study population consisted of 11,512 women with stage I ovarian cancer who had adnexectomy-based surgical staging including lymph node evaluation. Exposure allocation was based on SLN biopsy use. Main outcomes measured were (i) trends and characteristics associated with SLN biopsy use, assessed by multivariable logistic regression model, and (ii) overall survival assessed with inverse provability of treatment weighting propensity score.
SLN biopsy was performed in less than 1% of study population. In a multivariable analysis, recent surgery (2011-2018 versus 2003-2010, odds ratio [OR] 1.64, 95% confidence interval [CI] 1.03-2.59), smaller tumor size (< 10 versus ≥ 10 cm, OR 3.07, 95% CI 1.20-7.84), and East registry area (OR 2.74, 95% CI 1.73-4.36) remained independent characteristics for SLN biopsy use. In a propensity score weighted model, 5-year overall survival rate was 90.5% for the SLN biopsy-incorporated group and 88.6% for the lymphadenectomy group (hazard ratio 0.96, 95% CI 0.53-1.73).
SLN biopsy was rarely performed for early ovarian cancer surgery during the study period with insufficient evidence to interpret the survival effect. SLN biopsy in early ovarian cancer appears to be in early development phase, warranting further study and careful evaluation to assess feasibility and oncologic outcome.
前哨淋巴结（SLN）活检已被纳入多种恶性肿瘤的外科治疗；然而，其在卵巢癌中的应用尚未得到研究。本研究调查了早期卵巢癌中与SLN活检相关的人群水平趋势、特征和结局。
这是一项回顾性队列研究，查询了美国国立癌症研究所2003 - 2018年的监测、流行病学和最终结果计划。研究人群包括11512例I期卵巢癌女性，她们接受了以附件切除为基础的手术分期，包括淋巴结评估。暴露分配基于SLN活检的使用情况。主要测量结局为：（i）与SLN活检使用相关的趋势和特征，通过多变量逻辑回归模型评估；（ii）使用治疗加权倾向评分的逆概率评估总生存期。
SLN活检在不到1%的研究人群中进行。在多变量分析中，近期手术（2011 - 2018年与2003 - 2010年相比，比值比[OR] 1.64，95%置信区间[CI] 1.03 - 2.59）、较小的肿瘤大小（< 10 cm与≥ 10 cm相比，OR 3.07，95% CI 1.20 - 7.84）以及东部登记地区（OR 2.74，95% CI 1.73 - 4.36）仍然是SLN活检使用的独立特征。在倾向评分加权模型中，SLN活检纳入组的5年总生存率为90.5%，淋巴结清扫组为88.6%（风险比0.96，95% CI 0.53 - 1.73）。
在研究期间，早期卵巢癌手术中很少进行SLN活检，且缺乏足够证据来解释其生存效应。早期卵巢癌的SLN活检似乎处于早期发展阶段，需要进一步研究和仔细评估以评估其可行性和肿瘤学结局。
