背景:考虑到隐匿性子宫内膜癌的可能性,淋巴结状态赋予重要的预后和治疗数据,目前正在积极研究淋巴结评估在子宫内膜增生子宫切除术中的作用。本研究的目的是检查在非卧床手术中对子宫内膜增生进行微创子宫切除术时与淋巴结评估相关的特征。
方法:回顾性查询医疗成本和利用项目的全国门诊手术样本,以检查从2016年1月至2019年12月接受微创子宫切除术的49,698例子宫内膜增生患者。拟合多变量二元逻辑回归模型以评估与子宫切除术中淋巴结评估相关的特征,并构建具有递归分区分析的分类树模型以检查淋巴结评估的利用模式。
结果:对2847例(5.7%)患者进行了淋巴结评估。在多变量分析中,(I)年龄较大的患者因素,肥胖,人口普查水平较高的家庭收入,和大边缘大都市,(二)腹腔镜全子宫切除术和最近一年手术的手术因素,(iii)床容量大的医院参数,城市环境,和美国西部地区,和(iv)存在异型性的组织学因素与子宫切除术中淋巴结评估的利用率增加独立相关(所有,P<0.05)。在这些独立因素中,异型性的存在在淋巴结评估中表现出最大的关联(校正比值比3.75,95%置信区间3.39~4.16).根据组织学有20种独特的淋巴结评估模式,子宫切除术类型,患者年龄,手术年份,和医院病床容量,范围从0到20.3%(绝对率差异,20.3%)。
结论:在非卧床手术环境中进行子宫内膜增生的微创子宫切除术时的淋巴结评估似乎在发展,根据组织学类型有很大的变异性。子宫切除术方式,患者因素,和医院参数,有必要考虑制定临床实践指南。
Given the possibility of occult endometrial cancer where nodal status confers important prognostic and therapeutic data, role of lymph node evaluation at hysterectomy for endometrial hyperplasia is currently under active investigation. The objective of the current study was to examine the characteristics related to lymph node evaluation at the time of minimally invasive hysterectomy when performed for endometrial hyperplasia in an ambulatory surgery setting.
The Healthcare Cost and Utilization Project\'s Nationwide Ambulatory Surgery Sample was retrospectively queried to examine 49,698 patients with endometrial hyperplasia who underwent minimally invasive hysterectomy from 1/2016 to 12/2019. A multivariable binary logistic regression model was fitted to assess the characteristics related to lymph node evaluation at hysterectomy and a classification tree model with recursive partitioning analysis was constructed to examine the utilization pattern of lymph node evaluation.
Lymph node evaluation was performed in 2847 (5.7%) patients. In a multivariable analysis, (i) patient factors with older age, obesity, high census-level household income, and large fringe metropolitan, (ii) surgical factors with total laparoscopic hysterectomy and recent year surgery, (iii) hospital parameters with large bed capacity, urban setting, and Western U.S. region, and (iv) histology factor with presence of atypia were independently associated with increased utilization of lymph node evaluation at hysterectomy (all, P < 0.05). Among those independent factors, presence of atypia exhibited the largest association for lymph node evaluation (adjusted odds ratio 3.75, 95% confidence interval 3.39-4.16). There were 20 unique patterns of lymph node evaluation based on histology, hysterectomy type, patient age, year of surgery, and hospital bed capacity, ranging from 0 to 20.3% (absolute rate difference, 20.3%).
Lymph node evaluation at the time of minimally invasive hysterectomy for endometrial hyperplasia in the ambulatory surgery setting appears to be evolving with large variability based on histology type, hysterectomy modality, patient factors, and hospital parameters, warranting a consideration of developing clinical practice guidelines.