前哨淋巴结活检在合并高危因素子宫内膜癌中的应用与证据更新:精准分期时代的挑战与机遇
  • ISSN:3080-4302
  • DOI:10.64090/3080-4302.202608429
  • 出版频率:月刊
  • 语言:中文
  • 收录数据库:Crossref

前哨淋巴结活检在合并高危因素子宫内膜癌中的应用与证据更新:精准分期时代的挑战与机遇

金卓婷; 邱 娜 ; 郑茜文; 陈先凤; 王 丹(通讯作者)

绵阳市中心医院,四川 绵阳 621000

摘要:目的 综述前哨淋巴结活检(SLNB)在合并高危因素的子宫内膜癌中的应用与研究进展,并评估分子分型与病理超分期对分期、预后与治疗决策的影响。方法 综合FIGO 2023与 ESGO/ESTRO/ESP、NCCN等指南要点及近年前瞻性队列、数据库研究与荟萃分析的证据。结果 SLNB在低中危人群中的替代价值已确立;在早期高危子宫内膜癌患者中,若严格遵循SLNB规范并实施病理超分期,可获得可接受的诊断准确性与较高阴性预测值,但长期肿瘤学等效性仍待验证。分子分型可用于提示前哨淋巴结受累风险并优化术后治疗分层,尚不足以单独决定SLNB的适应证或方案。卵巢悬韧带上行通路可导致少数“盆腔淋巴结阴性,腹主动脉旁淋巴结阳性”的孤立转移,提示需对宫底/宫角或广泛,脉管浸润病例进行个体化上行评估。病理超分期可提高低体积转移的检出率,整体结局优于宏转移,孤立肿瘤细胞合并辅助治疗可能带来短期生存获益,但证据多为回顾性且存在异质性。结论 针对高危型子宫内膜癌,应以“标准化SLNB规范+病理超分期+可追溯的分子分型质控”为核心,结合多学科协作与共享决策,但其长期等效性与最优治疗强度仍需前瞻性研究阐明。

关键词:子宫内膜癌;前哨淋巴结活检;高危因素;病理超分期;低体积转移

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