Department of Obstetrics and Gynecology, Women's Cancer Center, Yonsei Cancer Center, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Seoul St. Mary's hospital, The Catholic University of Korea, Seoul, Korea.
J Gynecol Oncol. 2023 Nov;34(6):e79. doi: 10.3802/jgo.2023.34.e79. Epub 2023 Jul 7.
We aimed to investigate the oncologic outcomes of patients with endometrial cancer who underwent sentinel lymph node (SLN) biopsy without ultrastaging compared with that of those who underwent lymphadenectomy (LND).
Patients with endometrial cancer who underwent staging with SLN biopsy or LND during 2006 - 2021 were analyzed using propensity score matching (PSM). SLN metastasis was examined using hematoxylin and eosin staining, without ultrastaging. Progression-free survival (PFS) was compared between the two groups before and after PSM using age, histology, and stage as covariates. Clinical variables such as recurrence patterns and lymphatic complications, were assessed.
After excluding 213 patients who underwent validation LND with SLN biopsy, 902 were identified. The demographics of the remaining patients differed according to histology, myometrial invasion depth, and stage. Lymph node metastasis was less frequent in the SLN group than in the LND group (9.4% vs. 3.8%, p=0.004). The recurrence rates within 2 years were lower in the SLN group. The SLN group exhibited significantly superior 2-year and overall PFS than the LND group. Among patients with uterus-confined disease, overall PFS was favorable for SLN biopsy. After matching, differences in PFS were no longer observed, although the lymphocele and lymphedema rates were significantly lower in the SLN group.
In patients with endometrial cancer, SLN biopsy without ultrastaging did not compromise survival outcomes and was associated with significantly reduced lymphatic complication rates compared with LND. Therefore, SLN biopsy can be recommended for patients with endometrial cancer without definitive preoperative evidence of distant metastasis.
本研究旨在对比分析未行超分期的前哨淋巴结（SLN）活检与淋巴结切除术（LND）患者的子宫内膜癌患者的肿瘤学结局。
回顾性分析 2006 年至 2021 年期间行 SLN 活检或 LND 分期的子宫内膜癌患者，采用倾向评分匹配（PSM）进行分析。苏木精和伊红（H&E）染色用于检查 SLN 转移，未行超分期。使用年龄、组织学和分期作为协变量，在 PSM 前后比较两组的无进展生存期（PFS）。评估了复发模式和淋巴并发症等临床变量。
排除 213 例经 SLN 活检验证行 LND 的患者后，共纳入 902 例患者。根据组织学、肌层浸润深度和分期，剩余患者的人口统计学特征存在差异。SLN 组的淋巴结转移率低于 LND 组（9.4% vs. 3.8%，p=0.004）。SLN 组 2 年内的复发率较低。SLN 组的 2 年和总 PFS 明显优于 LND 组。在局限于子宫的疾病患者中，SLN 活检的总 PFS 良好。匹配后，PFS 差异不再明显，尽管 SLN 组的淋巴囊肿和淋巴水肿发生率显著降低。
在子宫内膜癌患者中，与 LND 相比，不进行超分期的 SLN 活检不会影响生存结局，且与显著降低的淋巴并发症发生率相关。因此，对于无明确术前远处转移证据的子宫内膜癌患者，可以推荐行 SLN 活检。
