de Menezes Jacqueline Nunes, Mataruco Daniel Mioto, Souza Raíssa Êmily Andrade, Guerra Gabriela Branquinho, Bomfim Beatriz Pâmella Costa, da Silveira Isadora, Uchoa Ana Thereza da Cunha, Baiocchi Glauco, Ramirez Pedro T
BP - A Beneficência Portuguesa de São Paulo, Department of Gynecologic Oncology, São Paulo, Brazil; IAMSPE - Instituto de Assistência Médica ao Servidor Público Estadual, Department of Surgical Oncology, São Paulo, Brazil.
Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Medical School, Porto Alegre, Brazil.
Int J Gynecol Cancer. 2025 Jul;35(7):101901. doi: 10.1016/j.ijgc.2025.101901. Epub 2025 Apr 23.
Sentinel lymph node (SLN) mapping has not been widely adapted in the setting of high-intermediate and high-risk endometrial cancer. The goal of this study was to determine oncologic outcomes in this high-intermediate or high-risk population undergoing SLN mapping compared with systematic pelvic ± para-aortic lymphadenectomy.
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, MEDLINE, Embase, and Cochrane databases were searched for trials comparing SLN with lymphadenectomy for patients with high- or high-intermediate-risk endometrial cancer. Studies were excluded if they lacked a control group, involved overlapping populations, were only available as abstracts, or were not in English. The main outcomes were overall survival, disease-free survival, recurrence, and adjuvant therapy rates. A pre-specified sub-group analysis was carried out that included high-risk patients, high-intermediate-risk patients, and only propensity score-matched studies. Statistical analysis was performed using RStudio Version 4.4.0. Heterogeneity was assessed using I statistics.
A total of 10 observational studies (2 with population data from the National Center for Biotechnology Information - NCBI and the Surveillance, Epidemiology and End Results - SEER databases) were included, evaluating a total of 6127 patients. There were no randomized control trials. There were no differences regarding overall survival (HR 0.82, 95% CI 0.60 to 1.11, p = .19, I = 36%) or disease-free survival (HR 0.85, 95% CI 0.67 to 1.08, p = .19, I = 0%) between SLN mapping and lymphadenectomy. Recurrence rates (OR 0.79, 95% CI 0.58 to 1.06, p = .12, I = 0%) and adjuvant therapy (OR 1.39, 95% CI 0.78 to 2.48, p = .26, I = 85%) were also similar between the groups. In a sub-group analysis including only the high-risk population, a statistically significant difference in overall survival favored SLN mapping compared with the lymphadenectomy (OR 0.62, 95% CI 0.44 to 0.89, p < .01, I = 0%). Similarly, the analysis of propensity score-matched studies showed better overall survival in the SLN cohort (OR 0.61, 95% CI 0.43 to 0.87, p < .01, I = 0%).
SLN mapping is associated with similar oncologic outcomes to lymphadenectomy in patients with high-intermediate and high-risk endometrial cancer. Routine lymphadenectomy should no longer be considered a standard of care.
前哨淋巴结（SLN）定位在高中度和高危子宫内膜癌的治疗中尚未得到广泛应用。本研究的目的是确定在接受SLN定位的高中度或高危人群中与系统性盆腔±腹主动脉旁淋巴结清扫术相比的肿瘤学结局。
按照系统评价和Meta分析的首选报告项目指南，检索MEDLINE、Embase和Cochrane数据库，查找比较SLN与淋巴结清扫术治疗高中度或高危子宫内膜癌患者的试验。如果研究缺乏对照组、涉及重叠人群、仅以摘要形式提供或不是英文的，则予以排除。主要结局为总生存期、无病生存期、复发率和辅助治疗率。进行了预先指定的亚组分析，包括高危患者、高中度高危患者以及仅倾向评分匹配的研究。使用RStudio 4.4.0版进行统计分析。使用I统计量评估异质性。
共纳入10项观察性研究（2项具有来自美国国立生物技术信息中心 - NCBI和监测、流行病学与最终结果 - SEER数据库的人群数据），共评估6127例患者。没有随机对照试验。SLN定位与淋巴结清扫术在总生存期（风险比[HR] 0.82，95%置信区间[CI] 0.60至1.11，p = 0.19，I = 36%）或无病生存期（HR 0.85，95% CI 0.67至1.08，p = 0.19，I = 0%）方面没有差异。两组之间的复发率（比值比[OR] 0.79，95% CI 0.58至1.06，p = 0.12，I = 0%）和辅助治疗率（OR 1.39，95% CI 0.78至2.48，p = 0.26，I = 85%）也相似。在仅包括高危人群的亚组分析中，与淋巴结清扫术相比，SLN定位在总生存期方面存在统计学显著差异（OR 0.62，95% CI 0.44至0.89，p < 0.01，I = 0%）。同样，倾向评分匹配研究的分析显示SLN队列的总生存期更好（OR 0.61，95% CI 0.43至0.87，p < 0.01，I = 0%）。
在高中度和高危子宫内膜癌患者中，SLN定位与淋巴结清扫术的肿瘤学结局相似。常规淋巴结清扫术不应再被视为标准治疗方法。
