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Does complete-staging lymphadenectomy improve survival outcomes in stage I endometrioid epithelial ovarian carcinoma? A multi-institutional retrospective study with propensity score-weighted analysis.

完整分期淋巴结清扫术能否改善I期子宫内膜样上皮性卵巢癌的生存结局?倾向评分加权分析的多机构回顾性研究。

  • 影响因子:2.04
  • DOI:10.1093/jjco/hyaa206
  • 作者列表:"Yoshihara M","Tamauchi S","Iyoshi S","Kitami K","Uno K","Tano S","Matsui S","Kajiyama H
  • 发表时间:2021-03-03
Abstract

BACKGROUND:We investigated the prognostic impact of complete-staging lymphadenectomy on patients with clinically apparent Stage I endometrioid epithelial ovarian carcinoma. METHODS:We conducted a regional multi-institutional retrospective study between 1986 and 2018. Amongst 4897 patients with malignant ovarian tumours diagnosed under central pathological review, 259 women with Stage I endometrioid epithelial ovarian carcinoma were eligible. We evaluated differences in survival of patients with both pelvic and para-aortic lymphadenectomy (Group A) and those with only pelvic lymphadenectomy and/or clinical lymph node evaluation (Group B). To analyse the therapeutic effects, the baseline imbalance between patients with both pelvic and para-aortic lymphadenectomy and others was adjusted with an inverse probability of treatment weighting using propensity score involving independent clinical variables. RESULTS:In total, 145 patients (56.0%) received both pelvic and para-aortic lymphadenectomy. With propensity score-based adjustment, estimated survival was better in Group A compared with that in Group B but not significant. Pelvic and para-aortic lymphadenectomy also led to no significant improvement of overall survival in most of the subgroups. However, point estimations of the hazard ratio for lymphadenectomy in patients with an age of 45 or younger (hazard ratio, 0.304; 95% confidence interval, 0.094-0.982), a Grade 1-2 (hazard ratio, 0.441; 95% confidence interval, 0.204-0.954) and T1c2-3 tumour (hazard ratio, 0.449; 95% confidence interval, 0.164-1.231) were better compared with those with the opposite characteristics. CONCLUSIONS:Complete-staging lymphadenectomy was not a significant prognostic factor in patients with Stage I endometrioid epithelial ovarian carcinoma, where we still need to explore appropriate candidate for the procedure.

摘要

背景: 我们研究了完全分期淋巴结清扫术对临床上明显的I期子宫内膜上皮性卵巢癌患者的预后影响。 方法: 我们在1986年至2018年间进行了一项区域性多机构回顾性研究。在中央病理学审查下诊断的4897例恶性卵巢肿瘤患者中,259例患有I期子宫内膜样上皮性卵巢癌的女性是合格的。我们评估了盆腔和主动脉旁淋巴结切除术患者 (A组) 和仅盆腔淋巴结切除术和/或临床淋巴结评估患者 (B组) 的生存率差异。为了分析治疗效果,使用涉及独立临床变量的倾向评分,用治疗加权的逆概率调整盆腔和主动脉旁淋巴结切除术患者与其他患者之间的基线失衡。 结果: 共有145例患者 (56.0%) 接受了盆腔和主动脉旁淋巴结清扫术。采用基于倾向评分的调整,A组的估计生存期优于B组,但不显著。盆腔和腹主动脉旁淋巴结清扫术也没有显著改善大多数亚组的总生存率。然而,对于年龄 ≤ 45岁的患者 (风险比,0.304; 95% 置信区间,0.094-0.982),1-2级 (风险比,0.441; 95% 置信区间,0.204-0.954) 和T1c2-3肿瘤 (风险比,0.449; 95% 置信区间,0.164-1.231) 优于相反特征者。 结论: 对于I期子宫内膜样上皮性卵巢癌患者,完全分期淋巴结清扫术不是一个重要的预后因素,我们仍然需要寻找合适的手术方案。

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