Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China.
Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China.
Eur J Obstet Gynecol Reprod Biol. 2022 Dec;279:94-101. doi: 10.1016/j.ejogrb.2022.10.013. Epub 2022 Oct 21.
The clinical value of lymph node dissection remains controversial. This study aimed to evaluate the impact of lymphadenectomy on the prognosis of patients with uterine leiomyosarcomas (uLMS) or endometrial stromal sarcomas (ESS). PubMed, EMBASE and the Cochrane Library were searched for studies describing the prognostic significance of lymphadenectomy in uLMS or ESS. Quality assessments were performed using the Newcastle-Ottawa Scale, relative hazard ratios and a random-effects model. Thirty-two retrospective cohort studies that included 26,693 patients in total were enrolled. Patients with uLMS or low-grade ESS (LG-ESS) had no survival benefits from lymphadenectomy. However, patients with high-grade ESS (HG-ESS), did show survival benefits of lymphadenectomy, with no heterogeneity. No significant evidence of publication bias was found. Lymphadenectomy had little prognostic effect on patients with early-stage uLMS or LG-ESS. The best treatment for HG-ESS is early, comprehensive hysterectomy with lymph node dissection.
淋巴结切除术的临床价值仍存在争议。本研究旨在评估淋巴结切除术对子宫平滑肌肉瘤（uLMS）或子宫内膜间质肉瘤（ESS）患者预后的影响。通过检索 PubMed、EMBASE 和 Cochrane Library，收集描述淋巴结切除术对 uLMS 或 ESS 预后意义的研究。采用纽卡斯尔-渥太华量表、相对危险比和随机效应模型进行质量评估。共纳入 32 项回顾性队列研究，共纳入 26693 例患者。uLMS 或低级别 ESS（LG-ESS）患者行淋巴结切除术无生存获益。然而，高级别 ESS（HG-ESS）患者行淋巴结切除术有生存获益，且无异质性。未发现发表偏倚的显著证据。淋巴结切除术对早期 uLMS 或 LG-ESS 患者的预后影响不大。HG-ESS 的最佳治疗方法是早期、全面的子宫切除术加淋巴结清扫。
