Mariani A, Webb M J, Keeney G L, Podratz K C
Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Gynecol Oncol. 2001 Apr;81(1):100-4. doi: 10.1006/gyno.2000.6111.
The goal of this work was to assess different patterns of lymphatic spread to pelvic and para-aortic lymph nodes (LNs) in endometrial cancer as a function of the location of tumor within the uterus.
Between 1984 and 1999, 625 patients with endometrial cancer were managed with hysterectomy and node dissection at our institution. The present study includes the 112 (18%) patients who had positive pelvic and/or para-aortic LNs; 41 (37%) of them had cervical involvement.
The external iliac was the most commonly involved pelvic LN site both in patients with tumor limited to the corpus and in those with cervical invasion. Isolated pelvic LN metastases to a single site were more frequently observed in external iliac LNs and obturator LNs in patients with tumor confined to the uterine corpus, whereas they occurred more commonly in external iliac and common iliac LNs in patients with cervical involvement. Metastasis to the common iliac LNs was more frequent in patients with disease extension to the cervix. In fact, common iliac LNs were positive in 67% of patients with cervical invasion, compared with only 30% of those with tumor confined to the uterine corpus (P < 0.01). Para-aortic LN invasion was significantly associated with obturator LN status. In fact, para-aortic LNs were positive in 64% of patients with positive obturator LNs compared with 23% of patients with negative obturator LNs (P = 0.01). All patients with positive para-aortic LNs and tumor invading the cervix had positive common iliac LNs. By contrast, when tumor was limited to the corpus, common iliac LNs were involved in only 27% of patients with positive para-aortic LNs.
External iliac LNs are the most commonly involved LNs in endometrial cancer. Compared with carcinomas limited to the uterine corpus, endometrial cancers invading the cervix spread more readily to the common iliac LNs. Furthermore, these data suggest that para-aortic LN metastases spread via a route shared by the common iliac LNs when tumor involves the cervix but spread predominantly via a route common to the obturator LNs (and/or external iliac LNs) when the primary tumor site is the corpus only.
本研究旨在评估子宫内膜癌盆腔和腹主动脉旁淋巴结（LN）的不同淋巴转移模式，作为肿瘤在子宫内位置的函数。
1984年至1999年间，我院对625例子宫内膜癌患者进行了子宫切除术和淋巴结清扫术。本研究纳入了112例（18%）盆腔和/或腹主动脉旁LN阳性的患者；其中41例（37%）有宫颈受累。
无论是肿瘤局限于子宫体的患者还是宫颈受侵的患者，髂外淋巴结都是盆腔LN最常受累的部位。在肿瘤局限于子宫体的患者中，孤立的盆腔LN转移至单个部位在髂外LN和闭孔LN中更常见，而在宫颈受累的患者中，它们更常见于髂外LN和髂总LN。髂总LN转移在疾病扩展至宫颈的患者中更常见。事实上，67%宫颈受侵患者的髂总LN阳性，而肿瘤局限于子宫体的患者中这一比例仅为30%（P<0.01）。腹主动脉旁LN侵犯与闭孔LN状态显著相关。事实上，闭孔LN阳性患者中64%的腹主动脉旁LN阳性，而闭孔LN阴性患者中这一比例为23%（P = 0.01）。所有腹主动脉旁LN阳性且肿瘤侵犯宫颈的患者髂总LN均阳性。相比之下，当肿瘤局限于子宫体时，腹主动脉旁LN阳性的患者中仅有27%的髂总LN受累。
髂外LN是子宫内膜癌最常受累的LN。与局限于子宫体的癌相比，侵犯宫颈的子宫内膜癌更容易扩散至髂总LN。此外，这些数据表明，当肿瘤累及宫颈时，腹主动脉旁LN转移通过髂总LN共享的途径扩散，但当原发肿瘤部位仅为子宫体时，主要通过闭孔LN（和/或髂外LN）共有的途径扩散。
