Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.
Int J Gynecol Cancer. 2022 Jul 4;32(7):875-881. doi: 10.1136/ijgc-2022-003431.
We aimed to evaluate the surgical and oncological outcomes of elderly patients with intermediate to high-risk endometrial cancer undergoing staging with sentinel lymph node (SLN) sampling and pelvic lymphadenectomy.
We conducted a retrospective study of elderly (>65-year-old) patients diagnosed with endometrial cancer between December 2007 and August 2017. These patients had been treated at a single center in Montreal, Canada. We compared the surgical and oncological outcomes of three cohorts undergoing surgical staging in non-overlapping eras: 1) lymphadenectomy, 2) lymphadenectomy and SLN sampling, 3) SLN sampling alone. Using life tables, Kaplan-Meier survival curves and log-rank tests, we analyzed 2-year progression-free survival, overall survival, and disease-specific survival.
Our study included 278 patients with a median age of 73 years (range; 65-91): 84 (30.2%) underwent lymphadenectomy, 120 (43.2%) underwent SLN sampling with lymphadenectomy, and 74 (26.6%) had SLN sampling alone. The SLN sampling alone group had shorter operative times with a median duration of 199 minutes (range, 75-393) compared with 231 (range, 125-403) and 229 (range, 151-440) minutes in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts; respectively (p<0.001). The SLN sampling alone group also had lower estimated blood loss with a median loss of 20 mL (range, 5-150) vs 25 mL (range, 5-800) and 40 mL (range, 5-400) in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts, respectively (p=0.002). The 2 year overall survival and progression-free survival were not significantly different between the three groups (p=0.45, p=0.51, respectively). On multivariable analysis after adjusting for age, American Society of Anesthesiologists (ASA) score, stage, grade, and lymphovascular space invasion, adding SLN sampling was associated with better overall survival, (HR 0.2, CI [0.1 to 0.6], p=0.006) and progression-free survival (HR 0.5, CI [0.1 to 1.0], p=0.05).
Sentinel lymph node-based surgical staging is feasible and associated with better surgical outcomes and comparable oncological outcomes in elderly patients with intermediate and highrisk endometrial cancer.
我们旨在评估接受前哨淋巴结（SLN）取样和盆腔淋巴结切除术的中高危子宫内膜癌老年患者的手术和肿瘤学结果。
我们对 2007 年 12 月至 2017 年 8 月期间在加拿大蒙特利尔的一家单一中心诊断为子宫内膜癌的老年（>65 岁）患者进行了回顾性研究。我们比较了在不重叠的时代进行手术分期的三个队列的手术和肿瘤学结果：1）淋巴结切除术，2）淋巴结切除术和 SLN 取样，3）仅 SLN 取样。使用寿命表、Kaplan-Meier 生存曲线和对数秩检验，我们分析了 2 年无进展生存率、总生存率和疾病特异性生存率。
我们的研究包括 278 名中位年龄为 73 岁（范围 65-91 岁）的患者：84 名（30.2%）接受了淋巴结切除术，120 名（43.2%）接受了 SLN 取样和淋巴结切除术，74 名（26.6%）仅接受了 SLN 取样。与 SLN 取样联合淋巴结切除术组（分别为 231 分钟，范围 125-403 分钟和 229 分钟，范围 151-440 分钟）相比，仅 SLN 取样组的手术时间更短，中位时间为 199 分钟（范围 75-393 分钟）（p<0.001）。仅 SLN 取样组的估计失血量也较低，中位数为 20 毫升（范围 5-150 毫升），而 SLN 取样联合淋巴结切除术组和淋巴结切除术组分别为 25 毫升（范围 5-800 毫升）和 40 毫升（范围 5-400 毫升）（p=0.002）。三组之间 2 年总生存率和无进展生存率无显著差异（p=0.45，p=0.51）。多变量分析调整年龄、美国麻醉医师协会（ASA）评分、分期、分级和脉管侵犯后，添加 SLN 取样与更好的总生存率相关（HR 0.2，CI [0.1 至 0.6]，p=0.006）和无进展生存率（HR 0.5，CI [0.1 至 1.0]，p=0.05）。
基于前哨淋巴结的手术分期是可行的，并且与中高危子宫内膜癌老年患者的手术结果更好，肿瘤学结果相当。
