Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Division of Gynecologic oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Gynecol Oncol. 2022 Oct;167(1):65-72. doi: 10.1016/j.ygyno.2022.08.009. Epub 2022 Aug 20.
The therapeutic effect of para-aortic lymphadenectomy in early-stage high-grade endometrial cancer remains controversial. In this study, we investigated whether combined pelvic and para-aortic lymphadenectomy has a survival benefit compared to pelvic lymphadenectomy alone in patients with pathologically diagnosed FIGO stage I-II grade 3 endometrioid and non-endometrioid endometrial cancers.
We retrospectively reviewed the medical records of 281 patients with histologically confirmed FIGO stage I-II grade 3 endometrioid and non-endometrioid endometrial cancers who underwent pelvic lymphadenectomy alone or combined pelvic and para-aortic lymphadenectomy in staging surgery at two tertiary centers in Korea and Taiwan. Prognostic factors to predict outcomes in these cases were also analyzed.
Among 281 patients, 144 underwent pelvic lymphadenectomy alone and 137 underwent combined pelvic and para-aortic lymphadenectomy. Within a median follow-up of 45 months, there was no significant difference in recurrence-free survival (RFS) and overall survival (OS) between the two groups. In multivariable analysis, age at diagnosis ≥60 years (HR = 2.20, 95% CI 1.25-3.87, p = 0.006) and positive lymph-vascular space invasion (LVSI) (HR = 2.79, 95% CI 1.60-4.85, p < 0.001) were associated with worse RFS, and only non-endometrioid histology was associated with worse OS (HR = 3.18, 95% CI 1.42-7.12, p = 0.005). In further subgroup analysis, beneficial effects of combined pelvic and para-aortic lymphadenectomy on RFS and OS were not observed.
In this study, combined pelvic and para-aortic lymphadenectomy could not improve survival compared to pelvic lymphadenectomy alone in patients with FIGO stage I-II grade 3 endometrioid and non-endometrioid endometrial cancers. Therefore, para-aortic lymphadenectomy may be omitted for these cases.
在早期高分级子宫内膜癌中，腹主动脉旁淋巴结切除术的治疗效果仍存在争议。本研究旨在探讨与单纯盆腔淋巴结切除术相比，对经病理诊断为国际妇产科联合会（FIGO）分期 I-II 期、组织学分级 3 的子宫内膜样和非子宫内膜样腺癌患者行盆腔和腹主动脉旁淋巴结切除术联合治疗是否具有生存获益。
我们回顾性分析了在韩国和中国台湾的 2 个三级中心行分期手术时，分别接受单纯盆腔淋巴结切除术或盆腔和腹主动脉旁淋巴结切除术联合治疗的 281 例经组织学证实为 FIGO 分期 I-II 期、组织学分级 3 的子宫内膜样和非子宫内膜样腺癌患者的病历。同时分析了这些病例的预后因素。
在 281 例患者中，144 例行单纯盆腔淋巴结切除术，137 例行盆腔和腹主动脉旁淋巴结切除术联合治疗。中位随访时间为 45 个月，两组间无复发生存率（RFS）和总生存率（OS）差异无统计学意义。多变量分析显示，诊断时年龄≥60 岁（HR=2.20，95%CI 1.25-3.87，p=0.006）和淋巴血管间隙浸润阳性（HR=2.79，95%CI 1.60-4.85，p<0.001）与 RFS 较差相关，而非子宫内膜样组织学与 OS 较差相关（HR=3.18，95%CI 1.42-7.12，p=0.005）。进一步的亚组分析显示，与单纯盆腔淋巴结切除术相比，盆腔和腹主动脉旁淋巴结切除术联合治疗并未改善 RFS 和 OS。
在本研究中，与单纯盆腔淋巴结切除术相比，对于 FIGO 分期 I-II 期、组织学分级 3 的子宫内膜样和非子宫内膜样腺癌患者，行盆腔和腹主动脉旁淋巴结切除术联合治疗并不能提高生存率。因此，对于这些病例，可以省略腹主动脉旁淋巴结切除术。
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