Influence of Lymphadenectomy on Survival for Early-Stage Endometrial Cancer.
Influence of Lymphadenectomy on Survival for Early-Stage Endometrial Cancer.
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DOI：
10.1097/aog.0000000000001194
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发表时间：
2016-01
影响因子：
7.2
通讯作者：
Hershman DL
中科院分区：
文献类型：
--
作者：
Wright JD;Huang Y;Burke WM;Tergas AI;Hou JY;Hu JC;Neugut AI;Ananth CV;Hershman DL
利用多种方法控制混杂因素和选择偏倚，以研究在一大群子宫内膜癌女性中淋巴结清扫术与生存之间的关联。
利用美国国家癌症数据库进行了一项回顾性队列研究，以确定1998 - 2011年间接受子宫切除术且伴有或不伴有淋巴结清扫术的子宫内膜样腺癌女性。使用传统回归分析、倾向评分以及将淋巴结清扫率的地区差异作为工具变量来研究淋巴结清扫术与生存之间的关联。
共确定了在1336家医院接受治疗的151089名女性；99052名（65.6%）患者接受了淋巴结清扫术，而52037名（34.4%）患者未接受。在多变量回归模型中，淋巴结清扫术与死亡率降低16%相关（风险比 = 0.84；95%置信区间，0.81 - 0.87）。在对辅助治疗进行调整后，结果相似（风险比 = 0.85；95%置信区间，0.82 - 0.87）。应用倾向评分分析后，结果基本未变，且表明淋巴结清扫术与生存改善相关。相比之下，在工具变量分析中，即使在对辅助治疗进行调整后（风险比 = 0.76；95%置信区间，0.54 - 1.06），淋巴结清扫术与生存之间也没有统计学上的显著关联（风险比 = 0.75；95%置信区间，0.53 - 1.06）。对于T1A和T1B肿瘤女性，结果未改变。
淋巴结清扫术对子宫内膜癌女性的生存即使有影响，也是很微小的。
To utilize a number of methods to control for confounding and selection bias to examine the association between lymphadenectomy and survival in a large cohort of women with endometrial cancer. A retrospective cohort study using the National Cancer Database was performed to identify women with endometrioid adenocarcinoma of the endometrium who underwent hysterectomy with or without lymphadenectomy from 1998–2011. Traditional regression analysis, propensity score and an instrumental variable using regional variation in the rate of lymphadenectomy as an instrument were used to examine the association between lymphadenectomy and survival. A total of 151,089 women treated at 1336 hospitals were identified; 99,052 (65.6%) patients underwent lymphadenectomy while 52,037 (34.4%) did not. In a multivariable regression model, lymphadenectomy was associated with a 16% reduction in mortality (HR=0.84; 95% CI, 0.81–0.87). The results were similar after adjustment for adjuvant therapy (HR=0.85; 95% CI, 0.82–0.87). The results were largely unchanged and suggested that lymphadenectomy was associated with improved survival after application of a propensity score analysis. In contrast, in the instrumental variable analysis there was not a statistically significant association between lymphadenectomy and survival (HR=0.75; 95% CI, 0.53–1.06), even after adjustment for adjuvant treatment (HR=0.76; 95% CI, 0.54–1.06). The results were unchanged for women with T1A and T1B tumors. Lymphadenectomy is associated with a modest, if any, effect on survival for women with endometrial cancer.