Bjerre Trent Pernille, Leitzinger Nils, Wang Yun, Dahl Gunn Fallås, Eyjólfsdóttir Brynhildur, Dahl Jørgen Fallås, Lund Kjersti Vassmo, Staff Anne Cathrine, Falk Ragnhild S, Eriksson Ane Gerda Z
Oslo University Hospital, Norwegian Radium Hospital, Department of Surgical Oncology, Division of Gynaecological Oncology, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, Norway.
University of Oslo, Institute of Basic Medical Sciences, Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Oslo, Norway.
Int J Gynecol Cancer. 2025 May;35(5):101810. doi: 10.1016/j.ijgc.2025.101810. Epub 2025 Apr 4.
The primary aim of this study was to compare the detection rates of nodal metastases between lymphadenectomy (LND) and sentinel lymph node (SLN) in intermediate- and high-risk patients with assumed uterine-confined disease.
This was a single-center observational study of patients from a tertiary referral center (2006-2023). Intermediate risk was defined as endometrioid adenocarcinoma grade 1/2 with ≥50% myoinvasion or grade 3 with <50% myoinvasion. High risk was defined as endometrioid adenocarcinoma grade 3 with ≥50% myoinvasion, non-endometrioid histologies regardless of myoinvasion or cervical involvement of any histology, and myoinvasion. All SLNs underwent pathologic ultra-staging. Nodal metastases were defined as the presence of macro- or micro-metastases. The comparison of metastatic lymph node rates by nodal assessment method was performed using the χ test and multivariable logistic regression analysis.
A total of 996 patients were included (333 in the intermediate-risk group and 663 in the high-risk group). In the intermediate-risk group 192/333 (58%) patients underwent LND and 141/333 (42%) underwent SLN. Nodal metastases were detected in 11% and 9% of the LND and SLN cohorts (p = .46). Increasing proportions of staged patients were observed after SLN implementation (57% vs 78%) (p < .001). In the high-risk group, 412/663 (62%) patients underwent LND, and 251/663 (38%) underwent SLN. Nodal metastases were detected in 19% and 14% of the LND and SLN cohorts, respectively (p = .11). The majority of isolated tumor cells were observed in endometrioid histologies compared to non-endometrioid histologies (71% vs 29%, p = .01). Increasing proportions of staged patients were observed after SLN implementation (82% vs 88%) (p = .02). In the multivariable analysis, no association was observed between the nodal assessment method and the detection rates of nodal metastases in either risk group.
In this predominantly high-risk population, the implementation of an SLN algorithm did not compromise the detection of nodal metastases. As more patients are comprehensively staged after SLN implementation, we expect more accurate surgical staging and adjuvant therapy allocation in this specific patient group in the future.
本研究的主要目的是比较在假定疾病局限于子宫的中高危患者中，淋巴结清扫术（LND）和前哨淋巴结（SLN）活检对淋巴结转移的检出率。
这是一项对来自三级转诊中心（2006 - 2023年）患者的单中心观察性研究。中度风险定义为1/2级子宫内膜样腺癌伴≥50%肌层浸润或3级伴<50%肌层浸润。高度风险定义为3级子宫内膜样腺癌伴≥50%肌层浸润、任何组织学类型的非子宫内膜样组织学（无论有无肌层浸润）、任何组织学类型的宫颈受累及肌层浸润。所有前哨淋巴结均接受病理超分期。淋巴结转移定义为存在宏观或微观转移。通过χ检验和多变量逻辑回归分析对不同淋巴结评估方法的转移淋巴结率进行比较。
共纳入996例患者（中度风险组333例，高度风险组663例）。在中度风险组中，192/333（58%）例患者接受了淋巴结清扫术，141/333（42%）例患者接受了前哨淋巴结活检。淋巴结清扫术组和前哨淋巴结活检组中分别有11%和9%的患者检测到淋巴结转移（p = 0.46）。在前哨淋巴结活检实施后，分期患者的比例有所增加（57%对78%）（p < 0.001）。在高度风险组中，412/663（62%）例患者接受了淋巴结清扫术，251/663（38%）例患者接受了前哨淋巴结活检。淋巴结清扫术组和前哨淋巴结活检组中分别有19%和14%的患者检测到淋巴结转移（p = 0.11）。与非子宫内膜样组织学相比，大多数孤立肿瘤细胞见于子宫内膜样组织学（71%对29%，p = 0.01）。在前哨淋巴结活检实施后，分期患者的比例有所增加（82%对88%）（p = 0.02）。在多变量分析中，在任何一个风险组中，均未观察到淋巴结评估方法与淋巴结转移检出率之间存在关联。
在这个以高危人群为主的研究中，前哨淋巴结活检算法的实施并未影响淋巴结转移的检出。由于在前哨淋巴结活检实施后有更多患者得到全面分期，我们预计未来在这个特定患者群体中手术分期会更准确，辅助治疗分配也会更合理。
