Sato R, Jobo T, Kuramoto H
Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa, Japan.
Eur J Gynaecol Oncol. 2003;24(3-4):241-5.
Parametrial spread of endometrial carcinoma, including the histopathological pattern of the spread and its significance as a prognostic factor, as well as its correlation with other prognostic factors are not well understood.
We reviewed histopathologically the resected parametria from 269 patients with endometrial carcinoma who underwent radical or modified radical hysterectomy with pelvic lymphadenectomy. The relationship between parametrial spread and other histopathological features, including histological type, tumor grade, depth of myometrial invasion, lymph vascular space invasion (LVSI) of the myometrium, cervical invasion, adnexal metastasis, lymph node metastasis and peritoneal cytology was studied. Clinical outcomes of the patients with parametrial spread were also evaluated.
Parametrial spread was demonstrated in 16 patients (5.9%). Direct invasion of cancer cells to connective tissue, LVSI and lymph-node metastasis in the parametrium were seen in 13, seven and three cases, respectively. Three patients had all three spread patterns. According to the FIGO surgical stage, parametrial spread was found in none of the 164 patients in Stage I, two (6.3%) of 32 in Stage II, 12 (16.9%) of 71 in Stage III, and two (100%) of two in Stage IV. The presence of parametrial involvement was significantly correlated with depth of myometrial invasion, cervical involvement, lymph-node metastasis, adnexal metastasis. LVSI in the myometrium and peritoneal cytology (each, p < 0.01). With a median follow-up of 68.3 months, six (37.5%) of 16 patients with parametrial involvement developed recurrence and died.
Direct parametrial extension or lymphatic involvement within the parametrium can occur in endometrial carcinoma. Patients with parametrial spread have a poor prognosis.
子宫内膜癌的宫旁组织扩散，包括扩散的组织病理学模式及其作为预后因素的意义，以及其与其他预后因素的相关性，目前尚未完全明确。
我们对269例行根治性或改良根治性子宫切除术加盆腔淋巴结清扫术的子宫内膜癌患者切除的宫旁组织进行了组织病理学检查。研究了宫旁组织扩散与其他组织病理学特征之间的关系，包括组织学类型、肿瘤分级、肌层浸润深度、肌层淋巴管间隙浸润（LVSI）、宫颈浸润、附件转移、淋巴结转移和腹腔细胞学检查。还评估了有宫旁组织扩散患者的临床结局。
16例患者（5.9%）出现宫旁组织扩散。分别有13例、7例和3例出现癌细胞直接侵犯结缔组织、宫旁组织LVSI和淋巴结转移。3例患者具有所有三种扩散模式。根据国际妇产科联盟（FIGO）手术分期，I期164例患者中均未发现宫旁组织扩散，II期32例中有2例（6.3%），III期71例中有12例（16.9%），IV期2例中有2例（100%）。宫旁组织受累与肌层浸润深度、宫颈受累、淋巴结转移、附件转移、肌层LVSI和腹腔细胞学检查均显著相关（均为p < 0.01）。中位随访68.3个月，16例宫旁组织受累患者中有6例（37.5%）复发并死亡。
子宫内膜癌可发生宫旁组织直接蔓延或宫旁组织内的淋巴受累。有宫旁组织扩散的患者预后较差。
