早期宫颈癌子宫切除术时前哨淋巴结活检:成本-效果分析

IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
A.R. Walker , S. Leite , Y.S. Chen , S.P. Huepenbecker , A. Graul
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引用次数: 0

摘要

目的早期宫颈癌的标准治疗方法是子宫切除并双侧盆腔淋巴结检查。基于前瞻性国际SENTIX试验的最终结果,我们试图确定早期宫颈癌淋巴结类型评估的成本效益(CE)。方法采用TreeAgePro 2023软件建立决策分析模型,评价子宫切除术时常规全淋巴结清扫(LND)不进行主动脉旁淋巴结清扫与前哨淋巴结清扫(SNLD)的策略。假设SLND组患者在单侧或双侧未定位的情况下分别进行单侧或双侧完全LND。结果包括成本、质量调整生命年(QALYs)、围手术期并发症、淋巴水肿和术后24个月的复发率。单变量和概率敏感性分析调查了这些策略的影响。结果在1000名女性的理论队列中,与常规LND相比,SLND是主要策略,导致1804个qaly,成本为2854万美元,增量成本-效果比(ICER)为83,693美元。这一策略导致53个围手术期并发症和77%的淋巴水肿病例减少。24个月时,SLND组复发率为62%,完全LND组复发率为89%。结论:与常规全LND相比,SLND是减少术后并发症和淋巴水肿的CE, ICER为- 83,693美元。在可行的情况下,应在子宫切除术时考虑这种手术技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sentinel lymph node biopsy at the time of hysterectomy for early-stage cervical cancer: A cost-effectiveness analysis

Objective

Standard management of early-stage cervical cancer is hysterectomy with bilateral pelvic lymph node evaluation. Based on the final results of the prospective international SENTIX Trial, we sought to determine the cost-effectiveness (CE) of type of lymph node assessment for early-stage cervical cancer.

Methods

A decision analytic model was created using TreeAgePro 2023 software to evaluate the strategies of routine full lymph node dissection (LND) without para-aortic node dissection verses sentinel lymph node dissection (SNLD) at the time of hysterectomy. It was assumed that patients in the SLND group underwent unilateral or bilateral full LND in the event of unilateral or bilateral non-mapping, respectively. Outcomes included cost, quality adjusted life years (QALYs), perioperative complications, lymphedema, and recurrence 24 months after surgery. Univariate and probabilistic sensitivity analyses investigated the impact of the strategies.

Results

In a theoretical cohort of 1000 women, SLND was the dominate strategy resulting in 1804 QALYs, cost $28.54 M, and incremental cost-effectiveness ratio (ICER) -$83,693, compared to routine LND. This strategy resulted in 53 total peri-operative complications and a 77 % reduction in lymphedema cases. At 24 months, the recurrence rate was 62 in the SLND group and 89 in the full LND group, respectively.

Conclusions

Compared to routine full LND, SLND is CE with a reduction in post-operative complications and lymphedema with an ICER of -$83,693. When feasible, this surgical technique should be considered at the time of hysterectomy.
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来源期刊
Gynecologic oncology
Gynecologic oncology 医学-妇产科学
CiteScore
8.60
自引率
6.40%
发文量
1062
审稿时长
37 days
期刊介绍: Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy
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