Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.
Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA.
J Surg Oncol. 2022 Dec;126(8):1543-1550. doi: 10.1002/jso.27069. Epub 2022 Aug 29.
This study examined the utilization and characteristics of lymph node evaluation at hysterectomy for carcinoma in situ of the uterine cervix.
This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample, evaluating 7395 patients with cervical carcinoma in situ who underwent hysterectomy from 2016 to 2019. A multivariable binary logistic regression model was fitted to identify independent characteristics related to lymph node evaluation. A classification-tree was constructed with recursive partitioning analysis to examine utilization patterns of lymph node evaluation.
Lymph node evaluation at hysterectomy was performed in 4.6%. In amultivariable analysis, older age, higher income, use of robotic-assisted hysterectomy, and surgery at large bed capacity or urban teaching centers in the northeast US region were associated with increased likelihood of lymph node evaluation (all, p < 0.05). Of those independent factors, robotic-assisted surgery exhibited the largest effect size (adjusted odds ratio 3.23, 95% confidence interval 2.54-4.10). Utilization pattern analysis identified nine unique characteristics, of which robotic-assisted surgery was the primary indicator for cohort allocation (12.4% vs. 3.2%, p < 0.001). The difference between the lowest-highest patterns was 33.3% (range, 0%-33.3%).
Lymph node evaluation was rarely performed for cervical carcinoma in situ overall and robotic surgery was associated with increased utilization of lymph node evaluation.
本研究探讨了宫颈癌前原位病变行子宫切除术时淋巴结评估的利用情况和特点。
本回顾性队列研究查询了医疗保健成本和利用项目的国家住院患者样本，评估了 2016 年至 2019 年间 7395 例宫颈癌前原位病变患者行子宫切除术的情况。采用多变量二项逻辑回归模型确定与淋巴结评估相关的独立特征。使用递归分区分析构建分类树，以检查淋巴结评估的利用模式。
4.6%的患者在行子宫切除术时进行了淋巴结评估。在多变量分析中，年龄较大、收入较高、使用机器人辅助子宫切除术以及在美国东北部地区大容量床位或城市教学中心进行手术与增加淋巴结评估的可能性相关（均，p<0.05）。在这些独立因素中，机器人辅助手术的效应量最大（调整后的优势比 3.23，95%置信区间 2.54-4.10）。利用模式分析确定了九个独特的特征，其中机器人辅助手术是队列分配的主要指标（12.4%比 3.2%，p<0.001）。最低和最高模式之间的差异为 33.3%（范围为 0%-33.3%）。
总体而言，宫颈癌前原位病变很少进行淋巴结评估，而机器人手术与淋巴结评估的利用率增加有关。
