调查子宫切除术期间进行淋巴结清扫是否可以提高接受新辅助化疗的临床 III 期子宫内膜癌患者的总体生存率。查询国家癌症数据库，将所有接受过术前化疗的临床 III 期子宫内膜癌患者确定为2004 年至 2020 年间，进行第一个疗程，随后进行子宫切除术，伴或不伴淋巴结清扫。采用单变量和多变量模型来研究影响总生存率的预后因素。本研究分析了 2882 名接受前期化疗的临床 III 期子宫内膜癌患者。在接受淋巴结清扫术的患者中，38% 的淋巴结呈阳性。与生存改善独立相关的因素包括淋巴结清扫术 (p<0.001)、辅助放疗 (p<0.001)、组织学 (p<0.001)、肿瘤分级 (p<0.001)、病理淋巴结状态 (p<0.001) 、年龄 (p<0.001)、保险类型 (p=0.027) 和种族 (p<0.001)。在子宫切除术时接受淋巴结清扫的患者的总生存期明显更好（107 个月 vs 85 个月；p<0.001）。多变量和倾向评分分析有力地证明，淋巴结清扫可显着改善总生存率（HR 0.69，95% CI 0.57 至 0.84，p<0.001），即使在淋巴结病理阴性的患者中也是如此。我们的研究表明，在淋巴结清扫术中进行对于所有接受前期化疗的 III 期子宫内膜癌患者，无论年龄、种族、保险状况、组织学亚型、肿瘤分级、病理淋巴结状态、辅助放疗或化疗，子宫切除术的时间与总生存期的改善相关。值得注意的是，患有高危疾病的患者可能特别受益于这种方法。© IGCS 和 ESGO 2024。禁止商业重复使用。请参阅权利和权限。由英国医学杂志出版。

To investigate whether performing a lymph node dissection during hysterectomy improves overall survival in patients with clinical stage III endometrial cancer who received neoadjuvant chemotherapy.The National Cancer Database was queried to identify all patients with clinical stage III endometrial cancer who had undergone pre-operative chemotherapy as first course of treatment followed by hysterectomy with or without lymph node dissection between the years 2004 and 2020. Univariable and multivariable models were performed to investigate prognostic factors on overall survival.This study analyzed 2882 patients with clinical stage III endometrial cancer who received upfront chemotherapy. Among those who underwent lymph node dissection, 38% had positive lymph nodes. Factors found to be independently associated with improved survival included lymph node dissection (p<0.001), adjuvant radiation (p<0.001), histology (p<0.001), tumor grade (p<0.001), pathologic node status (p<0.001), age (p<0.001), type of insurance (p=0.027), and race (p<0.001). Patients who underwent lymph node dissection at time of hysterectomy had a significantly better overall survival (107 vs 85 months; p<0.001). Multivariate and propensity score analyses robustly demonstrated that lymph node dissection significantly improved overall survival (HR 0.69, 95% CI 0.57 to 0.84, p<0.001), even among patients with pathologically negative lymph nodes.Our study suggests that performing lymph node dissection at the time of hysterectomy is associated with improved overall survival in all patients with stage III endometrial cancer who receive upfront chemotherapy, regardless of age, race, insurance status, histologic subtype, tumor grade, pathologic node status, adjuvant radiation or chemotherapy. Notably, patients with high-risk disease may particularly benefit from this approach.© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.