Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments
Identifieur interne : 002913 ( Main/Exploration ); précédent : 002912; suivant : 002914Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments
Auteurs : Takashi Mitamura [Japon] ; Hidemichi Watari [Japon] ; Yukiharu Todo [Japon] ; Tatsuya Kato [Japon] ; Yosuke Konno [Japon] ; Masayoshi Hosaka [Japon] ; Noriaki Sakuragi [Japon]Source :
- Journal of Gynecologic Oncology [ 2005-0380 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse de survie, Antigènes CA-125 (sang), Femelle, Humains, Imagerie par résonance magnétique (), Invasion tumorale, Lymphadénectomie, Métastase lymphatique, Procédures superflues, Pronostic, Récidive tumorale locale, Soins postopératoires (), Soins préopératoires (), Stade de la tumeur, Sujet âgé, Tumeurs de l'endomètre (), Tumeurs de l'endomètre (anatomopathologie).
- MESH :
- anatomopathologie : Tumeurs de l'endomètre.
- sang : Antigènes CA-125.
- Adulte, Adulte d'âge moyen, Analyse de survie, Femelle, Humains, Imagerie par résonance magnétique, Invasion tumorale, Lymphadénectomie, Métastase lymphatique, Procédures superflues, Pronostic, Récidive tumorale locale, Soins postopératoires, Soins préopératoires, Stade de la tumeur, Sujet âgé, Tumeurs de l'endomètre.
English descriptors
- KwdEn :
- Adult, Aged, CA-125 Antigen (blood), Endometrial Neoplasms (pathology), Endometrial Neoplasms (surgery), Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Magnetic Resonance Imaging (methods), Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Neoplasm Staging, Postoperative Care (methods), Preoperative Care (methods), Prognosis, Survival Analysis, Unnecessary Procedures.
- MESH :
- chemical , blood : CA-125 Antigen.
- methods : Magnetic Resonance Imaging, Postoperative Care, Preoperative Care.
- pathology : Endometrial Neoplasms.
- surgery : Endometrial Neoplasms.
- Adult, Aged, Female, Humans, Lymph Node Excision, Lymphatic Metastasis, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Survival Analysis, Unnecessary Procedures.
Abstract
According to the International Federation of Gynecology and Obstetrics staging, some surgeons perform lymphadenectomy in all patients with early stage endometrial cancer to enable the accurate staging. However, there are some risks to lymphadenectomy such as lower limb lymphedema. The aim of this study was to investigate whether preoperative assessment is useful to select the patients in whom lymphadenectomy can be safely omitted.
We evaluated the risk of lymph node metastasis (LNM) using LNM score (histological grade, tumor volume measured in magnetic resonance imaging [MRI], and serum CA-125), myometrial invasion and extrautrerine spread assessed by MRI. Fifty-six patients of which LNM score was 0 and myometrial invasion was less than 50% were consecutively enrolled in the study in which a lymphadenectomy was initially intended not to perform. We analyzed several histological findings and investigated the recurrence rate and overall survival.
Fifty-one patients underwent surgery without lymphadenectomy. Five (8.9%) who had obvious myometrial invasion intraoperatively underwent systematic lymphadenectomy. One (1.8%) with endometrial cancer which was considered to arise from adenomyosis had para-aortic LNM. Negative predictive value of deep myometrial invasion was 96.4% (54/56). During the mean follow-up period of 55 months, one patient with deep myometrial invasion who refused an adjuvant therapy had tumor recurrence. The overall survival rate was 100% during the study period.
This preoperative assessment is useful to select the early stage endometrial cancer patients without risk of LNM and to safely omit lymphadenectomy.
Url:
DOI: 10.3802/jgo.2014.25.4.301
PubMed: 25142623
PubMed Central: 4195300
Affiliations:
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first="Takashi" last="Mitamura">Takashi Mitamura</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Watari, Hidemichi" sort="Watari, Hidemichi" uniqKey="Watari H" first="Hidemichi" last="Watari">Hidemichi Watari</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Todo, Yukiharu" sort="Todo, Yukiharu" uniqKey="Todo Y" first="Yukiharu" last="Todo">Yukiharu Todo</name><affiliation wicri:level="1"><nlm:aff id="A2">Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Kato, Tatsuya" sort="Kato, Tatsuya" uniqKey="Kato T" first="Tatsuya" last="Kato">Tatsuya Kato</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Konno, Yosuke" sort="Konno, Yosuke" uniqKey="Konno Y" first="Yosuke" last="Konno">Yosuke Konno</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Hosaka, Masayoshi" sort="Hosaka, Masayoshi" uniqKey="Hosaka M" first="Masayoshi" last="Hosaka">Masayoshi Hosaka</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author><author><name sortKey="Sakuragi, Noriaki" sort="Sakuragi, Noriaki" uniqKey="Sakuragi N" first="Noriaki" last="Sakuragi">Noriaki Sakuragi</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Japon</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo</wicri:regionArea><wicri:noRegion>Sapporo</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of Gynecologic Oncology</title><idno type="ISSN">2005-0380</idno><idno type="eISSN">2005-0399</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>CA-125 Antigen (blood)</term><term>Endometrial Neoplasms (pathology)</term><term>Endometrial Neoplasms (surgery)</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Magnetic Resonance Imaging (methods)</term><term>Middle Aged</term><term>Neoplasm Invasiveness</term><term>Neoplasm Recurrence, Local</term><term>Neoplasm Staging</term><term>Postoperative Care (methods)</term><term>Preoperative Care (methods)</term><term>Prognosis</term><term>Survival Analysis</term><term>Unnecessary Procedures</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Antigènes CA-125 (sang)</term><term>Femelle</term><term>Humains</term><term>Imagerie par résonance magnétique ()</term><term>Invasion tumorale</term><term>Lymphadénectomie</term><term>Métastase lymphatique</term><term>Procédures superflues</term><term>Pronostic</term><term>Récidive tumorale locale</term><term>Soins postopératoires ()</term><term>Soins préopératoires ()</term><term>Stade de la tumeur</term><term>Sujet âgé</term><term>Tumeurs de l'endomètre ()</term><term>Tumeurs de l'endomètre (anatomopathologie)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>CA-125 Antigen</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Tumeurs de l'endomètre</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Magnetic Resonance Imaging</term><term>Postoperative Care</term><term>Preoperative Care</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Endometrial Neoplasms</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Antigènes CA-125</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Endometrial Neoplasms</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Lymph Node Excision</term><term>Lymphatic Metastasis</term><term>Middle Aged</term><term>Neoplasm Invasiveness</term><term>Neoplasm Recurrence, Local</term><term>Neoplasm Staging</term><term>Prognosis</term><term>Survival Analysis</term><term>Unnecessary Procedures</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Femelle</term><term>Humains</term><term>Imagerie par résonance magnétique</term><term>Invasion tumorale</term><term>Lymphadénectomie</term><term>Métastase lymphatique</term><term>Procédures superflues</term><term>Pronostic</term><term>Récidive tumorale locale</term><term>Soins postopératoires</term><term>Soins préopératoires</term><term>Stade de la tumeur</term><term>Sujet âgé</term><term>Tumeurs de l'endomètre</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>According to the International Federation of Gynecology and Obstetrics staging, some surgeons perform lymphadenectomy in all patients with early stage endometrial cancer to enable the accurate staging. However, there are some risks to lymphadenectomy such as lower limb lymphedema. The aim of this study was to investigate whether preoperative assessment is useful to select the patients in whom lymphadenectomy can be safely omitted.</p></sec><sec><title>Methods</title><p>We evaluated the risk of lymph node metastasis (LNM) using LNM score (histological grade, tumor volume measured in magnetic resonance imaging [MRI], and serum CA-125), myometrial invasion and extrautrerine spread assessed by MRI. Fifty-six patients of which LNM score was 0 and myometrial invasion was less than 50% were consecutively enrolled in the study in which a lymphadenectomy was initially intended not to perform. We analyzed several histological findings and investigated the recurrence rate and overall survival.</p></sec><sec><title>Results</title><p>Fifty-one patients underwent surgery without lymphadenectomy. Five (8.9%) who had obvious myometrial invasion intraoperatively underwent systematic lymphadenectomy. One (1.8%) with endometrial cancer which was considered to arise from adenomyosis had para-aortic LNM. Negative predictive value of deep myometrial invasion was 96.4% (54/56). During the mean follow-up period of 55 months, one patient with deep myometrial invasion who refused an adjuvant therapy had tumor recurrence. The overall survival rate was 100% during the study period.</p></sec><sec><title>Conclusion</title><p>This preoperative assessment is useful to select the early stage endometrial cancer patients without risk of LNM and to safely omit lymphadenectomy.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Pecorelli, S" uniqKey="Pecorelli S">S Pecorelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Ts" uniqKey="Lee T">TS Lee</name></author><author><name sortKey="Kim, Jw" uniqKey="Kim J">JW Kim</name></author><author><name sortKey="Kim, Sh" uniqKey="Kim S">SH Kim</name></author><author><name sortKey="Seong, Sj" uniqKey="Seong S">SJ Seong</name></author><author><name sortKey="Song, Es" uniqKey="Song E">ES Song</name></author><author><name sortKey="Kim, Jh" uniqKey="Kim J">JH Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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uniqKey="Alberto Lissoni A">A Alberto Lissoni</name></author><author><name sortKey="Signorelli, M" uniqKey="Signorelli M">M Signorelli</name></author><author><name sortKey="Scambia, G" uniqKey="Scambia G">G Scambia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kitchener, H" uniqKey="Kitchener H">H Kitchener</name></author><author><name sortKey="Swart, Am" uniqKey="Swart A">AM Swart</name></author><author><name sortKey="Qian, Q" uniqKey="Qian Q">Q Qian</name></author><author><name sortKey="Amos, C" uniqKey="Amos C">C Amos</name></author><author><name sortKey="Parmar, Mk" uniqKey="Parmar M">MK Parmar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, Jy" uniqKey="Lee J">JY Lee</name></author><author><name sortKey="Jung, Dc" uniqKey="Jung D">DC Jung</name></author><author><name sortKey="Park, Sh" uniqKey="Park S">SH Park</name></author><author><name sortKey="Lim, Mc" uniqKey="Lim M">MC Lim</name></author><author><name sortKey="Seo, Ss" uniqKey="Seo S">SS Seo</name></author><author><name sortKey="Park, Sy" uniqKey="Park S">SY Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kang, S" uniqKey="Kang S">S Kang</name></author><author><name sortKey="Kang, Wd" uniqKey="Kang W">WD Kang</name></author><author><name sortKey="Chung, Hh" uniqKey="Chung H">HH Chung</name></author><author><name sortKey="Jeong, Dh" uniqKey="Jeong D">DH Jeong</name></author><author><name sortKey="Seo, Ss" uniqKey="Seo S">SS Seo</name></author><author><name sortKey="Lee, Jm" uniqKey="Lee J">JM Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mariani, A" uniqKey="Mariani A">A Mariani</name></author><author><name sortKey="Dowdy, Sc" uniqKey="Dowdy S">SC Dowdy</name></author><author><name sortKey="Cliby, Wa" uniqKey="Cliby W">WA Cliby</name></author><author><name sortKey="Gostout, Bs" uniqKey="Gostout B">BS Gostout</name></author><author><name sortKey="Jones, Mb" uniqKey="Jones M">MB Jones</name></author><author><name sortKey="Wilson, To" uniqKey="Wilson T">TO Wilson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ballester, M" uniqKey="Ballester M">M Ballester</name></author><author><name sortKey="Dubernard, G" uniqKey="Dubernard G">G Dubernard</name></author><author><name sortKey="Bats, As" uniqKey="Bats A">AS Bats</name></author><author><name sortKey="Heitz, D" uniqKey="Heitz D">D Heitz</name></author><author><name sortKey="Mathevet, P" uniqKey="Mathevet P">P Mathevet</name></author><author><name sortKey="Marret, H" uniqKey="Marret H">H Marret</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Akbayir, O" uniqKey="Akbayir O">O Akbayir</name></author><author><name sortKey="Corbacioglu, A" uniqKey="Corbacioglu A">A Corbacioglu</name></author><author><name sortKey="Goksedef, Bp" uniqKey="Goksedef B">BP Goksedef</name></author><author><name sortKey="Numanoglu, C" uniqKey="Numanoglu C">C Numanoglu</name></author><author><name sortKey="Akca, A" uniqKey="Akca A">A Akca</name></author><author><name sortKey="Guraslan, H" uniqKey="Guraslan H">H Guraslan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Japon</li></country></list><tree><country name="Japon"><noRegion><name sortKey="Mitamura, Takashi" sort="Mitamura, Takashi" uniqKey="Mitamura T" first="Takashi" last="Mitamura">Takashi Mitamura</name></noRegion><name sortKey="Hosaka, Masayoshi" sort="Hosaka, Masayoshi" uniqKey="Hosaka M" first="Masayoshi" last="Hosaka">Masayoshi Hosaka</name><name sortKey="Kato, Tatsuya" sort="Kato, Tatsuya" uniqKey="Kato T" first="Tatsuya" last="Kato">Tatsuya Kato</name><name sortKey="Konno, Yosuke" sort="Konno, Yosuke" uniqKey="Konno Y" first="Yosuke" last="Konno">Yosuke Konno</name><name sortKey="Sakuragi, Noriaki" sort="Sakuragi, Noriaki" uniqKey="Sakuragi N" first="Noriaki" last="Sakuragi">Noriaki Sakuragi</name><name sortKey="Todo, Yukiharu" sort="Todo, Yukiharu" uniqKey="Todo Y" first="Yukiharu" last="Todo">Yukiharu Todo</name><name sortKey="Watari, Hidemichi" sort="Watari, Hidemichi" uniqKey="Watari H" first="Hidemichi" last="Watari">Hidemichi Watari</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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