前哨淋巴结活检联合病理超分期在子宫内膜癌中的研究

Study of sentinel lymph node biopsy combined with pathological ultrastaging in endometrial carcinoma

目的探讨在子宫内膜癌精准治疗中前哨淋巴结活检(sentinel lymph node biopsy,SLNB)联合病理超分期技术的临床价值。方法采用基于倾向得分匹配的回顾性队列研究方法,分析2018年8月至2020年8月于陆军军医大学第一附属医院妇产科因子宫内膜癌行腹腔镜全面分期手术的552例患者资料,其中43例行SLNB(SLNB组)并对前哨淋巴结行病理超分期、509例行系统性淋巴结切除(systematic lymphadenectomy,SLD)(SLD组),进行1∶2倾向得分匹配,以最小化两组间因基线特征不平衡而产生的偏差,最终获得SLNB组41例、SLD组82例。对比分析两组淋巴结检出的阳性率、临床病理分期的准确性、围手术期指标(手术时间、术中出血量和并发症发生率)等。结果123例患者中,SLNB组与SLD组相比,淋巴结检出的阳性率2.4%比1.2%,两组间差异无统计学意义(P>0.05);手术时间(128.0±38.2)min比(146.7±57.7)min、术中出血量(114.2±82.0)ml比(155.2±87.9)ml、术后并发症发生率0比1.2%,两组间差异有统计学意义(P<0.05);术后24 h内肛门排气率39.0%比28.0%、术后留置引流时间(1.4±1.4)d比(2.9±1.5)d、术后住院时间(5.6±2.9)d比(6.4±2.5)d,两组间差异无统计学意义(P>0.05)。结论在子宫内膜癌的治疗中,相比于SLD,SLNB联合病理超分期可以达到相似的淋巴结检出阳性率,但手术时间更短、术中出血量更少、术后并发症发生率相对更低。

Objective To discuss the clinical value of sentinel lymph node biopsy combined with pathological ultrastaging in the precise treatment of endometrial cancer.Methods A retrospective cohort study based on propensity score matching was designed to include 552 patients who underwent laparoscopic staging surgery for endometrial cancer in the Department of Obstetrics and Gynecology,The First Affiliated Hospital of The Army Medical University from Aug.2018 to Aug.2020,There were 43 cases with sentinel lymph node biopsy combined with pathological ultrastaging(SLNB group)and 509 cases with systematic lymphadenectomy(SLD group).A 1∶2 propensity score matching was performed to minimize the bias due to the imbalanced baseline features between the two groups.Finally,41 cases in SLNB group and 82 cases in SLD group were obtained.We compared and analyzed the positive rate of lymph node detection,accuracy of clinicopathological staging and perioperative indicators(such as operative time,intraoperative blood loss and incidence of complications).Results Among 123 patients,the SLNB group was compared with the SLD group,the positive rate of lymph node detection was(2.4%vs 1.2%),and there was no statistical difference between the two groups(P>0.05).The operative time was[(128.0±38.2)min vs(146.7±57.7)min],the intraoperative blood loss was[(114.2±82.0)ml vs(155.2±87.9)ml],and the incidence of postoperative complications was 0 vs 1.2%,of which the difference was statistically significant(P<0.05).There were no statistically significant differences in rate of anal exhaust within 24 h(39.0%vs 28.0%),postoperative indwelling drainage time[(1.4±1.4)d vs(2.9±1.5)d],postoperative hospital stay[(5.6±2.9)d vs(6.4±2.5)d]between the two groups(P>0.05).Conclusions Sentinel lymph node biopsy combined with pathological ultrastaging has similar detection rates as systematic lymphadenectomy in the treatment of endometrial cancer,but the former has shorter operative time,less intraoperative blood loss,and lower incidence of postoperative complications.