淋巴结切除对子宫腺肉瘤患者生存结局的影响  

The survival outcomes of lymphadenectomy on patients with uterine adenosarcoma

作　　者：赵辉[1] 王明 吴玉梅[1] ZHAO Hui;WANG Ming;WU Yu-mei(Department of Gynaecological Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院·北京妇幼保健院妇科肿瘤科,北京100006

出　　处：《川北医学院学报》2024年第7期985-990,共6页Journal of North Sichuan Medical College

摘　　要：目的:回顾性分析子宫腺肉瘤患者淋巴结切除与预后的关系。方法:回顾性分析2000年至2019年SEER数据库登记的子宫原发腺肉瘤患者的基本资料、肿瘤信息、治疗方式、随访时间及结局。比较淋巴结切除组与非淋巴结切除组的生存情况。采用最小绝对收缩和选择算子(LASSO)回归作为变量选择方法来确定预测模型的风险因素并建立淋巴结转移的风险预测模型。结果:共纳入1157例患者,发病年龄为(58.24±14.80)岁。进行倾向匹配评分均衡两组患者一般变量后,两组患者的肿瘤特征及治疗模式无显著差异。腹膜后淋巴结切除能明显降低患者的全因死亡率(P<0.05),并有降低肿瘤特异性死亡风险的趋势,但无统计学差异(P>0.05)。基于LASSO回归发现肿瘤的分期是预测子宫内膜癌腺肉瘤淋巴结转移的唯一有意义的预测变量。并建立了两个预测淋巴结转移的nomogram模型。其中模型一基于多个变量(淋巴结转移风险=0.5473×年龄+0.5112×种族+2.4058×肿瘤分级+0.1126×肿瘤分期-0.0751×肿瘤大小-11.3785)。模型二基于肿瘤分期(淋巴结转移风险=2.2093×肿瘤分期-7.2252)。模型一的AUC为0.985(95%CI∶0.975~0.996),优于模型二的AUC为0.541(95%CI∶0.438~0.644)。但模型二的决策曲线相比模型一具有更高的成本效益比。结论:淋巴结转移明显影响子宫腺肉瘤患的预后,腹膜后淋巴结切除能进一步改善患者的总体生存。本研究同时建立淋巴结转移的风险预测模型,值得临床推广。Objective:To retrospective analysis of the relationship between survival and lymphadenectomy in patients with adenosarcoma.Methods:This was a retrospective cohort study using SEER database to identify primary adenosarcoma from 2000 to 2019.Patient demographics,tumor information,treatment patterns,follow up time,and survival outcomes were collected.The impacts of lymphadenectomy on overall survival(OS)and cause specific survival(CSS)were evaluated respectively.Using Least Absolute Shrinkage and Selection Operator(LASSO)regression as a variable selection method to determine the risk factors of the predictive model,Establish a risk prediction model for lymph node metastasis.Prediction models were established to predict lymph node metastasis.Results:A total of 1,157 patients were included,and the mean age of onset was 58.24±14.80.There was no significant difference in tumor characteristics and treatment pattern between the two groups after propensity matching score was used to balance the baseline variables.Retroperitoneal lymphadenectomy significantly reduced all-cause mortality(P<0.05)and tended to reduce tumor-related mortality,although without statistical significance(P>0.05).LASSO regression revealed that tumor stage was the only significant predictor of lymph node metastasis of endometrial carcinoma adenosarcoma.Two nomogram models were established to predict lymph node metastasis,model 1 was based on multiple variables(lymph node metastasis risk=0.5473*age+0.5112*race+2.4058*tumor grade+0.1126*tumor stage-0.0751*tumor size-11.3785).Model 2 was based on tumor stage(lymph node metastasis risk=2.2093*tumor stage-7.2252).The AUC of Model 1 was 0.985(95%CI∶0.975~0.996),which was better than 0.541 of Model 2(95%CI:0.438~0.644).The decision curve of Model 2 showed a higher cost-benefit ratio than model 1.Conclusion:Lymph node metastasis significantly affects the prognosis of patients with uterine adenosarcoma.Retroperitoneal lymph node resection can further improve the overall survival of patients.This study also

关 键 词：子宫腺肉瘤 淋巴结切除 生存 风险预测模型 

分 类 号：R737.33[医药卫生—肿瘤]