Benseler Anouk, Vicus Danielle, Covens Allan, Kupets Rachel, Parra-Herran Carlos, Gien Lilian T
Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
Int J Gynaecol Obstet. 2025 Mar;168(3):1258-1263. doi: 10.1002/ijgo.15937. Epub 2024 Oct 14.
To determine the accuracy of pelvic sentinel lymph node biopsy (SLN) in detecting positive para-aortic (PA) lymph nodes in high-grade uterine cancer, and to determine the recurrence rate in patients with high-grade uterine cancers who did not receive adjuvant chemotherapy based on negative pelvic SLNs.
This was a retrospective cohort study of patients with newly diagnosed, high-grade endometrial cancer who underwent surgery, including pelvic SLNs with or without PA node dissection, at a tertiary care institution between 2015 and 2020. Baseline demographics, surgical management, pathology data, and outcomes were analyzed using descriptive statistics, and survival analysis.
Postoperative histology of the 110 patients meeting inclusion criteria was 45.5% grade 3 endometrioid, 36.4% serous, 10.9% clear cell, and 7.3% carcinosarcoma. On final pathology, 63.7% were stage 1, and 23.6% were stage 3C with positive nodes. A total of 63 patients (57.3%) had a PA lymph node dissection (56 bilateral, 7 unilateral) in addition to the pelvic SLN. Among this group, 5.8% (95% confidence interval 1.2%-16.0%) had a positive PA node despite a negative pelvic SLN. Among those with a negative pelvic SLN and no adjuvant chemotherapy (n = 75), the rate of distant recurrence was 14.7%, and 3-year recurrence-free survival was 71.9%.
The rate of isolated PA node metastasis in high-grade endometrial cancers despite a negative pelvic SLN may be significantly higher than the accepted rate of isolated PA node metastasis in low-grade endometrial cancer. This supports adjuvant treatment decisions continuing to incorporate primary tumor pathology and molecular classification.
确定盆腔前哨淋巴结活检（SLN）在检测高级别子宫癌腹主动脉旁（PA）淋巴结转移中的准确性，并确定基于盆腔SLN阴性未接受辅助化疗的高级别子宫癌患者的复发率。
这是一项对2015年至2020年期间在一家三级医疗机构接受手术（包括有或无PA淋巴结清扫的盆腔SLN）的新诊断高级别子宫内膜癌患者的回顾性队列研究。使用描述性统计和生存分析对基线人口统计学、手术管理、病理数据和结果进行分析。
符合纳入标准的110例患者术后组织学类型为45.5%的3级子宫内膜样癌、36.4%的浆液性癌、10.9%的透明细胞癌和7.3%的癌肉瘤。最终病理结果显示，63.7%为1期，23.6%为3C期且伴有阳性淋巴结。除盆腔SLN外，共有63例患者（57.3%）进行了PA淋巴结清扫（56例双侧，7例单侧）。在该组患者中，尽管盆腔SLN阴性，但5.8%（95%置信区间1.2%-16.0%）的患者PA淋巴结为阳性。在盆腔SLN阴性且未接受辅助化疗的患者（n = 75）中，远处复发率为14.7%，3年无复发生存率为71.9%。
尽管盆腔SLN阴性，但高级别子宫内膜癌中孤立PA淋巴结转移的发生率可能显著高于低级别子宫内膜癌中公认的孤立PA淋巴结转移发生率。这支持辅助治疗决策继续纳入原发肿瘤病理和分子分类。
