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.
Eur J Obstet Gynecol Reprod Biol. 2022 Aug;275:91-96. doi: 10.1016/j.ejogrb.2022.06.018. Epub 2022 Jun 24.
Sentinel lymph node (SLN) biopsy is increasingly utilized at surgical staging for early endometrial cancer. This study examined the association between SLN biopsy and micrometastasis in endometrial cancer.
This is a retrospective cohort study examining the National Cancer Institute's Surveillance, Epidemiology, and End Result Program. The study population was 6,414 women with T1-2 endometrial cancer who underwent primary hysterectomy and surgical nodal evaluation. Exclusion criteria included cases with isolated tumor cells. Exposure assignment was surgical nodal evaluation (SLN biopsy or lymphadenectomy). Main outcome measure was micrometastasis, assessed by inverse probability of treatment weighting propensity score in a stage-specific fashion.
In T1a disease (n = 4,608), SLN biopsy was performed in 1,164 (25.3%) cases. SLN biopsy was associated with a 90% increased likeliness of identifying micrometastasis compared to lymphadenectomy (1.3% versus 0.7%, odds ratio 1.90, 95% confidence interval 1.02-3.55, P = 0.040). In T1b disease (n = 1,369), 270 (19.7%) cases had SLN biopsy. The incidence of micrometastasis was significantly higher in the SLN biopsy group compared to the lymphadenectomy group (8.4% versus 5.0%, odds ratio 1.74, 95% confidence interval 1.06-2.86, P = 0.028). In T2 disease (SLN biopsy in 57 [13.0%] of 437 cases), the incidence of micrometastasis was similar between the two groups (7.9% versus 7.0%, odds ratio 0.88, 95% confidence interval 0.30-2.60, P = 0.818).
This study suggests that SLN biopsy protocol may identify more micrometastasis in the regional lymph nodes of T1 endometrial cancer. Whether national-level increase in the utilization of SLN biopsy for early endometrial cancer results in a stage-shifting to advanced disease on a population-basis warrants further investigation.
前哨淋巴结（SLN）活检在早期子宫内膜癌的外科分期中应用日益广泛。本研究旨在探讨 SLN 活检与子宫内膜癌微转移之间的关系。
这是一项回顾性队列研究，纳入了美国国家癌症研究所的监测、流行病学和最终结果（SEER）数据库。研究人群为 6414 例接受了原发性子宫切除术和外科淋巴结评估的 T1-2 期子宫内膜癌患者。排除标准包括孤立肿瘤细胞的病例。暴露分配为外科淋巴结评估（SLN 活检或淋巴结切除术）。主要观察指标为微转移，采用逆概率治疗加权倾向评分在特定分期下进行评估。
在 T1a 疾病（n=4608）中，1164 例（25.3%）患者行 SLN 活检。与淋巴结切除术相比，SLN 活检更有可能发现微转移（1.3%比 0.7%，优势比 1.90，95%置信区间 1.02-3.55，P=0.040）。在 T1b 疾病（n=1369）中，270 例（19.7%）患者行 SLN 活检。与淋巴结切除术组相比，SLN 活检组的微转移发生率显著更高（8.4%比 5.0%，优势比 1.74，95%置信区间 1.06-2.86，P=0.028）。在 T2 疾病（57 例[13.0%]接受 SLN 活检）中，两组的微转移发生率相似（7.9%比 7.0%，优势比 0.88，95%置信区间 0.30-2.60，P=0.818）。
本研究表明，SLN 活检方案可能会在 T1 期子宫内膜癌的区域淋巴结中发现更多的微转移。在全国范围内增加 SLN 活检用于早期子宫内膜癌是否会导致疾病分期向晚期转移，有待进一步研究。
