Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy.
University of Udine, Udine, Italy.
Int J Gynecol Cancer. 2023 Sep 4;33(9):1370-1375. doi: 10.1136/ijgc-2023-004692.
To assess the oncologic outcomes of sentinel lymph node biopsy alone as part of surgical management in patients with early-stage cervical cancer.
A systematic search of the literature was performed following the PRISMA checklist. MEDLINE (through PubMed), EMBASE, and Scopus databases were searched from June 1991 to May 2023. Studies of women with early-stage cervical cancer International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA, of any age or histology, and articles only in English language were included. After the removal of duplicates, only articles including sentinel node mapping alone compared with full pelvic lymphadenectomy were retained.
Four studies with a total of 2226 patients were included. Among these, 354 (15.9%) underwent sentinel lymph node biopsy alone. A total of 2210 (99.2%) patients had FIGO 2009 stage I disease and 1514 (68%) patients had squamous cell carcinoma. Median body mass index was 25.5 kg/m (range 23.5-27). Lymph vascular space invasion was present in 633 patients (34%) who underwent full lymphadenectomy and in 78 patients (22%) who underwent sentinel node biopsy alone. The results of the survival analysis showed that there was no significant difference in the 3-year progression-free survival rates of patients who underwent either sentinel biopsy alone or lymphadenectomy. Three-year recurrence-free survival was 93.1% (95% CI 28.3% to 64.7%) for patients who underwent sentinel node biopsy alone and 92.5% (95% CI 39.0% to 53.4%) for patients who underwent sentinel node biopsy and lymphadenectomy (p=0.773).
In patients with early-stage cervical cancer, performing sentinel lymph node biopsy alone compared with pelvic lymphadenectomy does not appear to independently confer a higher risk or recurrence.
评估单独进行前哨淋巴结活检作为早期宫颈癌患者手术治疗一部分的肿瘤学结果。
按照 PRISMA 清单进行系统文献检索。从 1991 年 6 月至 2023 年 5 月，检索 MEDLINE（通过 PubMed）、EMBASE 和 Scopus 数据库。纳入的研究对象为国际妇产科联合会（FIGO）2009 分期为 IA-IIA 期的任何年龄和组织学类型的早期宫颈癌女性患者，且仅限英文文献。去除重复项后，仅保留单独进行前哨淋巴结绘图与全盆腔淋巴结清扫相比的文章。
纳入了 4 项共 2226 例患者的研究。其中，354 例（15.9%）患者单独接受了前哨淋巴结活检。共有 2210 例（99.2%）患者为 FIGO 2009 分期 I 期疾病，1514 例（68%）患者为鳞状细胞癌。中位体质指数为 25.5kg/m²（范围 23.5-27）。行全淋巴结清扫术的 633 例（34%）患者和行单独前哨淋巴结活检的 78 例（22%）患者存在淋巴血管空间浸润。生存分析结果显示，单独行前哨活检或淋巴结清扫术的患者 3 年无进展生存率无显著差异。单独行前哨淋巴结活检的患者 3 年无复发生存率为 93.1%（95%CI 28.3%至 64.7%），而行前哨淋巴结活检和淋巴结清扫术的患者为 92.5%（95%CI 39.0%至 53.4%）（p=0.773）。
在早期宫颈癌患者中，与盆腔淋巴结清扫术相比，单独进行前哨淋巴结活检似乎不会独立增加复发风险。
