I期子宮內(nèi)膜癌淋巴結(jié)切除有必要嗎

CochraneDatabaseSystRev.2010Jan20;(1):CD007585.Lymphadenectomyforthemanagementofendometrialcancer.MayK,BryantA,DickinsonHO,KehoeS,MorrisonJUniversityofOxford,Women'sCentreNoevidencethatlymphadenectomydecreasestheriskofdeathordiseaserecurrencecomparedwithnolymphadenectomyinwomenwithpresumedstageIdisease.Theevidenceonseriousadverseeventssuggeststhatwomenwhoreceivelymphadenectomyaremorelikelytoexperiencesurgicallyrelatedsystemicmorbidityorlymphoedema/lymphocystformation.JNatlCancerInst.2008Dec3;100(23):1707-16.Epub2008Nov25Systematicpelviclymphadenectomyvs.nolymphadenectomyinearly-stageendometrialcarcinoma:randomizedclinicaltrial.Rome,Italy

CONCLUSION:Althoughsystematicpelviclymphadenectomystatisticallysignificantlyimprovedsurgicalstaging,itdidnotimprovedisease-freeoroverallsurvival.Lancet.2009Jan10;373(9658):125-36.Epub2008Dec16.Efficacyofsystematicpelviclymphadenectomyinendometrialcancer(MRCASTECtrial):arandomisedstudy.Collaborators(180)

AmosC,BlakeP,BransonA,BuckleyCH,RedmanCW,ShepherdJ,DunnG,HeintzP,YarnoldJ,JohnsonP,MasonM,RuddR,BadmanP,BegumS,ChadwickN,CollinsS,GoodallK,JenkinsJ,LawK,MookP,SandercockJ,GoldsteinC,UscinskaB,CruickshankM,ParkinDE,CrawfordRA,LatimerJ,MichelM,ClarkeJ,DobbsS,McClellandRJ,PriceJH,ChanKK,MannC,RandR,FishA,LambM,GoodfellowC,TahirS,SmithJR,GornallR,Kerr-WilsonR,SwinglerGR,LaveryBA,ChanKK,KehoeS,FlavinA,EddyJ,Davies-HumphriesJ,HockingM,Sant-CassiaLJ,PearsonS,ChapmanRL,HodgkinsJ,ScottI,GuthrieD,PersicM,DanielFN,YiannakisD,AlloubMI,GilbertL,HeslipMR,NordinA,SmartG,CowieV,KatesmarkM,MurrayP,EddyJ,GornallR,SwinglerGR,FinnCB,MoloneyM,FarthingA,HanochJ,MasonPW,McIndoeA,SoutterWP,TebbuttH,MorganJS,VaseyD,CruickshankDJ,NevinJ,KehoeS,McKenzieIZ,GieC,DaviesQ,IrelandD,KirwanP,DaviesQ,LambM,KingstonR,KirwanJ,HerodJ,FianderA,LimK,HeadAC,LynchCB,BrowningAJ,CoxC,MurphyD,DuncanID,MckenzieC,CrockerS,NietoJ,PatersonME,TidyJ,DuncanA,ChanS,WilliamsonKM,WeekesA,AdeyemiOA,HenryR,LaurenceV,DeanS,PooleD,LindMJ,DealeyR,GodfreyK,HatemMM,LopesA,MonaghanJM,NaikR,EvansJ,GillespieA,PatersonME,TidyJ,IndT,LaneJ,OatesS,RedfordD,FordM,FishA,Larsen-DisneyP,JohnsonN,BolgerA,KeatingP,Martin-HirschP,RichardsonL,MurdochJB,JeyarajahA,LambM,McWhinneyN,FarthingA,MasonPW,KitchenerH,BeynonJL,HogstonP,LowEM,WoolasR,AndersonR,MurdochJB,NivenPA,Kerr-WilsonR,ChinK,FlynnP,FreitesO,NewmanGH,McNallyO,CullimoreJ,OlaitanA,MouldT,MenonV,RedmanCW,GeorgeM,HatemMH,EvansA,FianderA,HowellsR,LimK,CawdellG,WarwickAP,EustaceD,GilesJ,LeesonS,NevinJ,vanWijkAL,KarolewskiK,KlimekM,BlecharzP,McConnellD.

Hysterectomyandbilateralsalpingo-oophorectomy(BSO)isthestandardsurgeryforstageIendometrialcancer.Systematicpelviclymphadenectomyhasbeenusedtoestablishwhetherthereisextra-uterinediseaseandasatherapeuticproceduremedianfollow-upof37months(IQR24-58)191womenhaddied:88/704standardsurgerygroup103/704lymphadenectomygroup251Recurrentdisease107/704standardsurgerygroup144/704lymphadenectomygroup)INTERPRETATIONnoevidenceofbenefitintermsofoverallorrecurrence-freesurvivalforpelviclymphadenectomyinwomenwithearlyendometrialcancer.Pelviclymphadenectomycannotberecommendedasroutineprocedurefortherapeuticpurposesoutsideofclinicaltrials.早期：淋巴結(jié)轉(zhuǎn)移率較低國內(nèi)中山腫瘤：臨床Ⅰ7.9%,Ⅱ8.6%,Ⅲ38.4%浙江腫瘤：臨床Ⅰ4.4%,Ⅱ14%，Ⅲ34.8%國外StageⅠb（a）G1-2或IaG3：轉(zhuǎn)移率0-2%StageⅠb（a）G3或Ic（b）G1：轉(zhuǎn)移率16%-20%早期：LND并未降低復(fù)發(fā)改善生存“沖鋒在前”的意大利研究生存上沒有差異復(fù)發(fā)時間和復(fù)發(fā)率相似復(fù)發(fā)部位相似改變觀念無容置疑淋巴結(jié)真的可以不切除嗎？LesionsitesandregionDepthofmyometrialinvasionCervicalinvasionExtrauterineinvasionornot,singleormultiplePathologicalgradeandclassificationLymphvascularinvasion(LVI)淋巴轉(zhuǎn)移相關(guān)因素病灶大小與淋巴結(jié)轉(zhuǎn)移TumorSizeLNmets:

2cm4%>2cm15%entireuterinecavity35%5-ysurvival:

2cm-98%>2cm-84%entireuterinecavity-64%

腹膜后淋巴結(jié)切除指征淋巴結(jié)切除范圍一定要切除腹主動脈旁淋巴結(jié)嗎？EurJGynaecolOncol.2007;28(2):98-102.

PrinceofWalesHospital,Shatin,HongKongIsaorticlymphadenectomynecessaryinthemanagementofendometrialcarcinoma?75(46.0%)pelviclymphadenectomyalone88(54.0%)hadbothpelvicandaorticlymphadenectomy35(21.5%)nodalmetastasespositivepelvic26(16.0%)positiveaortic24(27.3%)Isolatedaorticmetastases17cases(19.3%)35patientswithnodalmetastasesrecurrencedevelopedin15(42.9%)andallexceptonediedwithinfiveto50monthsTherecurrenceratewashigher(63.6%)amongpatientswithupperaorticlymphnodemetastasesallthosewhorecurreddiedofdiseasewithinsevento28months.CONCLUSIONSaorticlymphadenectomyprovidesbothdiagnosticandtherapeuticvalueinthemanagementofendometria