预测子宫内膜癌患者前哨淋巴结示踪失败的因素：系统评价和荟萃分析。

Predictive factors of sentinel lymph node failed mapping in endometrial carcinoma patients: a systematic review and meta-analysis.

机构信息

Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

出版信息

Int J Gynecol Cancer. 2023 Jun 5;33(6):853-859. doi: 10.1136/ijgc-2022-004014.

DOI:10.1136/ijgc-2022-004014

PMID:36914172

Abstract

OBJECTIVE

In endometrial carcinoma patients, sentinel lymph node bilateral mapping fails in 20-25% of cases, with several factors affecting the likelihood of detection. However, pooled data about predictive factors of failure are lacking. The aim of this systematic review and meta-analysis was to assess the predictive factors of sentinel lymph node failed mapping in endometrial cancer patients undergoing sentinel lymph node biopsy.

METHODS

A systematic review and a meta-analysis was performed searching all studies assessing predictive factors of sentinel lymph node failed mapping in apparent uterine-confined endometrial cancer patients undergoing sentinel lymph node biopsy through the cervical injection of indocyanine green. The associations between sentinel lymph node failed mapping and predictive factors of failure were assessed, calculating the odds ratio (OR) with 95% confidence intervals.

RESULTS

Six studies with a total of 1345 patients were included. Compared with patients with sentinel lymph node bilateral successful mapping, patients with sentinel lymph node failed mapping showed: OR 1.39 (p=0.41) for body mass index >30 kg/m; OR 1.72 (p=0.24) for menopausal status; OR 1.19 (p=0.74) for adenomyosis; OR 0.86 (p=0.55) for prior pelvic surgery; OR 2.38 (p=0.26) for prior cervical surgery; OR 0.96 (p=0.89) for prior Cesarean section; OR 1.39 (p=0.70) for lysis of adhesions during surgery before sentinel lymph node biopsy; OR 1.77 (p=0.02) for indocyanine green dose <3 mL; OR 1.28 (p=0.31) for deep myometrial invasion; OR 1.21 (p=0.42) for International Federation of Gynecology and Obstetrics (FIGO) grade 3; OR 1.89 (p=0.01) for FIGO stages III-IV; OR 1.62 (p=0.07) for non-endometrioid histotype; OR 1.29 (p=0.25) for lymph-vascular space invasion; OR 4.11 (p<0.0001) for enlarged lymph nodes; and OR 1.71 (p=0.022) for lymph node involvement.

CONCLUSION

Indocyanine green dose <3 mL, FIGO stage III-IV, enlarged lymph nodes, and lymph node involvement are predictive factors of sentinel lymph node failed mapping in endometrial cancer patients.

摘要

目的

在子宫内膜癌患者中，前哨淋巴结双侧定位失败的比例为 20-25%，有几个因素会影响检测的可能性。然而，关于失败预测因素的综合数据尚缺乏。本系统评价和荟萃分析的目的是评估在接受前哨淋巴结活检的子宫内膜癌患者中，前哨淋巴结失败定位的预测因素。

方法

通过宫颈注射吲哚菁绿，对所有评估前哨淋巴结失败定位的预测因素的研究进行系统评价和荟萃分析，这些研究均为明显子宫内局限的子宫内膜癌患者接受前哨淋巴结活检。评估前哨淋巴结失败定位与失败预测因素之间的关系，计算比值比（OR）及其 95%置信区间。

结果

共纳入 6 项研究，总计 1345 例患者。与前哨淋巴结双侧成功定位的患者相比，前哨淋巴结失败定位的患者：体质量指数（BMI）>30kg/m2 的 OR 为 1.39（p=0.41）；绝经状态的 OR 为 1.72（p=0.24）；子宫腺肌病的 OR 为 1.19（p=0.74）；盆腔手术史的 OR 为 0.86（p=0.55）；宫颈手术史的 OR 为 2.38（p=0.26）；剖宫产史的 OR 为 0.96（p=0.89）；前哨淋巴结活检前手术松解粘连的 OR 为 1.39（p=0.70）；吲哚菁绿剂量<3ml 的 OR 为 1.77（p=0.02）；深肌层浸润的 OR 为 1.28（p=0.31）；国际妇产科联合会（FIGO）分级 3 的 OR 为 1.21（p=0.42）；FIGO 分期 III-IV 的 OR 为 1.89（p=0.01）；非子宫内膜样组织学类型的 OR 为 1.62（p=0.07）；淋巴管血管间隙浸润的 OR 为 1.29（p=0.25）；淋巴结肿大的 OR 为 4.11（p<0.0001）；淋巴结受累的 OR 为 1.71（p=0.022）。