Abstract：
OBJECTIVE: To investigate whether performing a lymph node dissection during hysterectomy improves overall survival in patients with clinical stage III endometrial cancer who received neoadjuvant chemotherapy.
METHODS: The National Cancer Database was queried to identify all patients with clinical stage III endometrial cancer who had undergone pre-operative chemotherapy as first course of treatment followed by hysterectomy with or without lymph node dissection between the years 2004 and 2020. Univariable and multivariable models were performed to investigate prognostic factors on overall survival.
RESULTS: This study analyzed 2882 patients with clinical stage III endometrial cancer who received upfront chemotherapy. Among those who underwent lymph node dissection, 38% had positive lymph nodes. Factors found to be independently associated with improved survival included lymph node dissection (p<0.001), adjuvant radiation (p<0.001), histology (p<0.001), tumor grade (p<0.001), pathologic node status (p<0.001), age (p<0.001), type of insurance (p=0.027), and race (p<0.001). Patients who underwent lymph node dissection at time of hysterectomy had a significantly better overall survival (107 vs 85 months; p<0.001). Multivariate and propensity score analyses robustly demonstrated that lymph node dissection significantly improved overall survival (HR 0.69, 95% CI 0.57 to 0.84, p<0.001), even among patients with pathologically negative lymph nodes.
CONCLUSIONS: Our study suggests that performing lymph node dissection at the time of hysterectomy is associated with improved overall survival in all patients with stage III endometrial cancer who receive upfront chemotherapy, regardless of age, race, insurance status, histologic subtype, tumor grade, pathologic node status, adjuvant radiation or chemotherapy. Notably, patients with high-risk disease may particularly benefit from this approach.
METHODS: The National Cancer Database was queried to identify all patients with clinical stage III endometrial cancer who had undergone pre-operative chemotherapy as first course of treatment followed by hysterectomy with or without lymph node dissection between the years 2004 and 2020. Univariable and multivariable models were performed to investigate prognostic factors on overall survival.
RESULTS: This study analyzed 2882 patients with clinical stage III endometrial cancer who received upfront chemotherapy. Among those who underwent lymph node dissection, 38% had positive lymph nodes. Factors found to be independently associated with improved survival included lymph node dissection (p<0.001), adjuvant radiation (p<0.001), histology (p<0.001), tumor grade (p<0.001), pathologic node status (p<0.001), age (p<0.001), type of insurance (p=0.027), and race (p<0.001). Patients who underwent lymph node dissection at time of hysterectomy had a significantly better overall survival (107 vs 85 months; p<0.001). Multivariate and propensity score analyses robustly demonstrated that lymph node dissection significantly improved overall survival (HR 0.69, 95% CI 0.57 to 0.84, p<0.001), even among patients with pathologically negative lymph nodes.
CONCLUSIONS: Our study suggests that performing lymph node dissection at the time of hysterectomy is associated with improved overall survival in all patients with stage III endometrial cancer who receive upfront chemotherapy, regardless of age, race, insurance status, histologic subtype, tumor grade, pathologic node status, adjuvant radiation or chemotherapy. Notably, patients with high-risk disease may particularly benefit from this approach.
摘要：
目的：探讨在子宫切除术中进行淋巴结清扫术是否能改善临床III期子宫内膜癌患者接受新辅助化疗的总生存率。
方法：对国家癌症数据库进行了查询，以确定所有临床III期子宫内膜癌患者，这些患者在2004年至2020年期间接受了术前化疗作为第一疗程，然后进行了子宫切除术，有或没有淋巴结清扫。使用单变量和多变量模型来研究总体生存的预后因素。
结果：本研究分析了2882例临床III期子宫内膜癌患者接受前期化疗。在接受淋巴结清扫的人中，38%淋巴结阳性。发现与生存改善独立相关的因素包括淋巴结清扫术（p<0.001），辅助放射（p<0.001），组织学（p<0.001），肿瘤分级（p<0.001），病理淋巴结状态（p<0.001），年龄（p<0.001），保险类型(p=0.027)，和种族（p<0.001）。在子宫切除术时进行淋巴结清扫的患者总生存期明显较好（107vs85个月；p<0.001）。多因素和倾向评分分析有力地表明，淋巴结清扫术显著改善了总生存率(HR0.69,95%CI0.57to0.84,p<0.001)。甚至在病理阴性淋巴结的患者中。
结论：我们的研究表明，在接受前期化疗的所有III期子宫内膜癌患者中，在子宫切除术时进行淋巴结清扫与改善总生存期相关。不管年龄,种族,保险状况,组织学亚型，肿瘤分级,病理淋巴结状态，辅助放疗或化疗。值得注意的是,高危疾病患者可能特别受益于这种方法.
方法：对国家癌症数据库进行了查询，以确定所有临床III期子宫内膜癌患者，这些患者在2004年至2020年期间接受了术前化疗作为第一疗程，然后进行了子宫切除术，有或没有淋巴结清扫。使用单变量和多变量模型来研究总体生存的预后因素。
结果：本研究分析了2882例临床III期子宫内膜癌患者接受前期化疗。在接受淋巴结清扫的人中，38%淋巴结阳性。发现与生存改善独立相关的因素包括淋巴结清扫术（p<0.001），辅助放射（p<0.001），组织学（p<0.001），肿瘤分级（p<0.001），病理淋巴结状态（p<0.001），年龄（p<0.001），保险类型(p=0.027)，和种族（p<0.001）。在子宫切除术时进行淋巴结清扫的患者总生存期明显较好（107vs85个月；p<0.001）。多因素和倾向评分分析有力地表明，淋巴结清扫术显著改善了总生存率(HR0.69,95%CI0.57to0.84,p<0.001)。甚至在病理阴性淋巴结的患者中。
结论：我们的研究表明，在接受前期化疗的所有III期子宫内膜癌患者中，在子宫切除术时进行淋巴结清扫与改善总生存期相关。不管年龄,种族,保险状况,组织学亚型，肿瘤分级,病理淋巴结状态，辅助放疗或化疗。值得注意的是,高危疾病患者可能特别受益于这种方法.
