Lutman Christopher V, Havrilesky Laura J, Cragun Janiel M, Secord Angeles Alvarez, Calingaert Brian, Berchuck Andrew, Clarke-Pearson Daniel L, Soper John T
Riverside Gynecologic Oncology, Columbus, OH 43214, USA.
Gynecol Oncol. 2006 Jul;102(1):92-7. doi: 10.1016/j.ygyno.2005.11.032. Epub 2006 Jan 10.
To determine whether pelvic lymph node count is associated with patterns of recurrence or survival in patients with FIGO stage I and II endometrial cancer.
Single institution retrospective study of 467 patients with FIGO stage I and II endometrial cancer treated with primary surgery including lymph node dissection. Analysis included pelvic lymph node count, histology, stage, age, race, BMI, year of surgery, depth of myometrial invasion, and adjuvant radiation. Kaplan-Meier life-tables were used to calculate survival; the Cox proportional hazards model was used to identify prognostic factors independently associated with survival.
Mean pelvic lymph node count was 12.6 (SD +/- 8). Distant recurrence was associated with decreased pelvic lymph node count, high-risk histology, and postoperative pelvic radiation. Pelvic lymph node count was not associated with survival by univariate analysis, however, overall (OS) and progression-free (PFS) survival were significantly better with pelvic lymph node counts >or=12 among women with high-risk histology (P < 0.001), but not among women with low-risk histology. Multivariable Cox proportional hazards regression identified increasing age, non-Caucasian race, and high-risk histology as independent negative prognostic factors for both OS and PFI. Among patients with high-risk histology, pelvic lymph node count remained an independent prognostic factor for both overall (OS) and progression-free survival (PFS) in the model, with hazard ratios of 0.28 and 0.29, respectively, when >or=12 pelvic lymph nodes were identified. Pelvic lymph node count had no association with OS or PFS in women with low-risk histology.
Pelvic lymph node count >or=12 is an important prognostic variable in patients with FIGO stage I and II endometrial cancer who have high-risk histology. Most likely, the association of survival and lymph node count in this group is the result of improved staging among patients with higher pelvic lymph node counts.
确定国际妇产科联盟（FIGO）I期和II期子宫内膜癌患者的盆腔淋巴结计数是否与复发模式或生存率相关。
对467例接受包括淋巴结清扫在内的初次手术治疗的FIGO I期和II期子宫内膜癌患者进行单机构回顾性研究。分析内容包括盆腔淋巴结计数、组织学类型、分期、年龄、种族、体重指数、手术年份、肌层浸润深度和辅助放疗。采用Kaplan-Meier生存表计算生存率；使用Cox比例风险模型确定与生存独立相关的预后因素。
盆腔淋巴结平均计数为12.6（标准差±8）。远处复发与盆腔淋巴结计数减少、高危组织学类型和术后盆腔放疗相关。单因素分析显示盆腔淋巴结计数与生存率无关，然而，高危组织学类型的女性盆腔淋巴结计数≥12时，总生存期（OS）和无进展生存期（PFS）显著更好（P<0.001），而低危组织学类型的女性则不然。多变量Cox比例风险回归分析确定年龄增加、非白种人种族和高危组织学类型是OS和PFI的独立阴性预后因素。在高危组织学类型的患者中，盆腔淋巴结计数在模型中仍然是总生存期（OS）和无进展生存期（PFS）的独立预后因素，当识别出≥12个盆腔淋巴结时，风险比分别为0.28和0.29。盆腔淋巴结计数与低危组织学类型女性的OS或PFS无关。
盆腔淋巴结计数≥12是FIGO I期和II期高危组织学类型子宫内膜癌患者的重要预后变量。很可能，该组患者生存与淋巴结计数的关联是盆腔淋巴结计数较高患者分期改善的结果。
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