Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol. 2023 Jan;168:1-7. doi: 10.1016/j.ygyno.2022.10.017. Epub 2022 Nov 2.
To compare outcomes of patients with premalignant endometrial pathology undergoing hysterectomy with or without sentinel lymph node (SLN) removal. Outcomes of interest included surgical adverse events (AEs), cancer status on final pathology, postoperative treatment, and The Cancer Genome Atlas (TCGA) molecular risk profiles.
We retrospectively identified patients with premalignant pathology on preoperative endometrial biopsy who underwent hysterectomy with or without SLN mapping/excision at our institution from 01/01/2017-12/31/2021. Clinical, pathologic, surgical, and TCGA profiling data were abstracted. Appropriate statistical tests were used.
Of 221 patients identified, 161 (73%) underwent hysterectomy with SLN excision and 60 (27%) underwent hysterectomy without SLN excision. Median age and body mass index were similar between groups. Median operative time was 130 min for those who underwent SLN mapping/excision versus 136 min for those who did not (p = 0.6). Thirty-day postoperative AE rates were 9% (n = 15/161) and 13% (n = 8/60), respectively (p = 0.9). Ninety-eight (44%) of 221 patients had grade 1-2 endometrioid endometrial cancer on final pathology (4 [4%] were stage IB or higher). Ten (10%) of 98 patients, all within the SLN group, received adjuvant treatment. Among all patients, of 33 (15%) with TCGA molecular classification data, 27 (82%) had copy number-low, 3 (9%) microsatellite instability-high, 2 (6%) POLE-ultramutated, and 1 (3%) copy number-high disease.
SLN assessment appears safe, detects a small number of occult nodal metastases for those upstaged, and provides additional staging information that can guide adjuvant treatment. SLN mapping should be discussed in preoperative counseling and offered using a shared decision-making approach.
比较行子宫切除术的有癌前子宫内膜病变患者与有或无前哨淋巴结（SLN）切除患者的结局。感兴趣的结局包括手术不良事件（AE）、最终病理的癌症状态、术后治疗以及癌症基因组图谱（TCGA）分子风险谱。
我们回顾性地确定了 2017 年 1 月 1 日至 2021 年 12 月 31 日在我院行子宫切除术的术前子宫内膜活检有癌前病变的患者，这些患者中有或无 SLN 图谱/切除。提取临床、病理、手术和 TCGA 分析数据。使用适当的统计检验。
在 221 例患者中，161 例（73%）行子宫切除术+SLN 切除，60 例（27%）行子宫切除术+无 SLN 切除。两组的中位年龄和体重指数相似。行 SLN 图谱/切除的患者中位手术时间为 130 分钟，而行无 SLN 切除的患者为 136 分钟（p=0.6）。30 天术后 AE 发生率分别为 9%（n=15/161）和 13%（n=8/60）（p=0.9）。98 例（44%）患者的最终病理为 1-2 级子宫内膜样腺癌（4 例[4%]为 IB 期或更高）。10 例（10%）患者接受了辅助治疗，这 10 例均在 SLN 组。在所有患者中，33 例（15%）有 TCGA 分子分类数据，其中 27 例（82%）为拷贝数低，3 例（9%）为微卫星不稳定高，2 例（6%）为 POLE-超突变，1 例（3%）为拷贝数高。
SLN 评估似乎是安全的，对于那些分期升高的患者，可检测到少量隐匿性淋巴结转移，并提供可指导辅助治疗的额外分期信息。应在术前咨询中讨论 SLN 图谱，并使用共同决策方法提供。
