Madom L M, Brown A K, Lui F, Moore R G, Granai C O, Disilvestro P A
Program in Women's Oncology, Women and Infants' Hospital, One Blackstone Place, Providence, RI 02905, USA.
Gynecol Oncol. 2007 Oct;107(1):75-8. doi: 10.1016/j.ygyno.2007.05.026. Epub 2007 Jul 16.
Several predictive factors for lymph node spread in endometrial cancer have been identified including tumor grade, depth of invasion, lymphatic or vascular-space invasion, and histologic subtype. Lower uterine segment involvement may also be predictive of lymph node spread. The objective of this study was to investigate the relationship between lower uterine segment involvement in endometrial carcinoma and lymph node spread.
This was an IRB approved retrospective study. Data were collected for all patients diagnosed with endometrial cancer from June 1999 to December 2004. The primary end point was the presence of nodal involvement. Subset analysis was performed by histologic subtype. Univariate and multivariate nominal logistic regression was performed. Categorical variables were compared using Chi-square and Fischer's Exact Test.
Two-hundred and ninety-nine subjects were eligible for review. One-hundred seventy four (58%) had lower uterine segment involvement. Forty-four (25%) of those with lower uterine segment involvement had positive nodes compared to 10 (8%) of those without (p=0.0001). On univariate analysis, lower uterine segment involvement, lymphovascular-space invasion, and deep invasion predicted nodal disease. On multivariate analysis, lower uterine segment remained predictive of nodal spread for the endometrioid subset. For high-risk histologies, only lymphovascular-space invasion and deep myometrial invasion were predictive of nodal spread.
Lower uterine segment involvement in endometrial carcinoma is an important predictor of lymph node involvement for patients with endometrioid histologies. Tumor within the lower uterine segment may be an important factor to consider in intraoperative decision making regarding staging.
已确定子宫内膜癌淋巴结转移的几个预测因素，包括肿瘤分级、浸润深度、淋巴或血管间隙浸润以及组织学亚型。子宫下段受累也可能是淋巴结转移的预测指标。本研究的目的是探讨子宫内膜癌子宫下段受累与淋巴结转移之间的关系。
这是一项经机构审查委员会批准的回顾性研究。收集了1999年6月至2004年12月期间所有诊断为子宫内膜癌的患者的数据。主要终点是淋巴结受累情况。按组织学亚型进行亚组分析。进行单变量和多变量名义逻辑回归分析。使用卡方检验和费舍尔精确检验比较分类变量。
299名受试者符合审查条件。174名（58%）有子宫下段受累。子宫下段受累的患者中有44名（25%）淋巴结阳性，而无子宫下段受累的患者中有10名（8%）淋巴结阳性（p=0.0001）。单变量分析显示，子宫下段受累、淋巴血管间隙浸润和深度浸润可预测淋巴结疾病。多变量分析显示，对于子宫内膜样亚型，子宫下段仍然是淋巴结转移的预测指标。对于高危组织学类型，只有淋巴血管间隙浸润和子宫肌层深度浸润可预测淋巴结转移。
子宫内膜癌子宫下段受累是子宫内膜样组织学患者淋巴结受累的重要预测指标。子宫下段内的肿瘤可能是术中分期决策时需要考虑的重要因素。
