Lymph node dissection in endometrial cancer and clinical outcome: A population-based study in 5546 patients
Lymph node dissection in endometrial cancer and clinical outcome: A population-based study in 5546 patients
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DOI：
10.1016/j.ygyno.2019.04.002
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发表时间：
2019-07-01
影响因子：
4.7
通讯作者：
Engel, J.
中科院分区：
文献类型：
--
作者：
Poelcher, M.;Rottmann, M.;Engel, J.
背景资料。根据目前的治疗指南，局限于子宫的子宫内膜癌的综合手术分期取决于子宫危险因素：高危患者建议进行系统性淋巴清扫(LND)，低危患者应省略系统淋巴清扫。它在中高风险患者中的作用尚不确定。这项分析的目的是回顾所采取的战略的实施情况。数据由以人口为基础的慕尼黑癌症登记中心提供。纳入1998-2016年间确诊的子宫内膜癌患者。在5446例符合条件的患者中，低危组占58.5%，中高危组占30.1%，高危组占11.4%。淋巴结清扫率分别为20.2%、53.0%和63.7%。淋巴结转移率分别为1.7%、9.6%和19.3%。在这些危险组中，有无LND的患者在局部复发、淋巴结复发或远处转移的时间上没有显著差异。在调整了年龄和合并症状态后，总体存活率没有发现显著差异。在现实生活中，LND在早期子宫内膜癌中的应用与手术治疗不足和过度治疗的高比率有关。相应的生存数据并未显示系统性淋巴清扫术的显著益处。为了在未来改善早期子宫内膜癌的治疗和预后，前瞻性试验、新的手术理念和预后标志物将是主要和必要的。(C)2019 Elsevier Inc.保留所有权利。
Background. According to current treatment guidelines, comprehensive surgical staging procedures in endometrial cancer confined to the uterus depend on uterine risk factors: a systematic lymph node dissection (LND) is recommended in high risk patients and should be omitted in low risk patients. Its role in intermediate and high intermediate risk patients is inconclusive. The aim of this analysis was to review the implementation of this risk adopted strategy.Materials and methods. Data were provided by the population-based Munich Cancer Registry. Patients with endometrial cancer diagnosed between 1998 and 2016 were included.Results. Of 5446 eligible patients, 58.5%, 30.1% and 11.4% belonged to the low risk, intermediate/high-intermediate and high risk group, respectively. Lymph node dissection was performed in 20.2%, 53.0% and 63.7% within these groups. Lymph node involvement was diagnosed in 1.7%, 9.6% and 19.3%, respectively. Within these risk groups, there was no significant difference in the time to local recurrence, lymph node recurrence or distant metastases between patients with and without LND. After adjusting for age and comorbidity-status, no significant difference in overall survival was found.Conclusions. The application of a risk-adopted management of LND in early endometrial cancer in real-life is associated with a high rate of surgical under- and overtreatment. Corresponding survival data do not show a significant benefit of a systematic lymph node dissection. In order to improve the management and outcome of early endometrial cancer in the future, prospective trials, new surgical concepts and prognostic markers will be primary and necessary. (C) 2019 Elsevier Inc. All rights reserved.