Axtell Allison E, Kelley Joseph L, Fader Amanda Nickles, Gupta Dilip, Schwartz Benjamin, Comerci John T, Lin Yan, Weiand Samuel, Gallion Holly H, Kanbour-Shakir Amal
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Magee-Women's Hospital of University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, Pennsylvania 15213, USA.
Gynecol Oncol. 2007 Dec;107(3):482-6. doi: 10.1016/j.ygyno.2007.08.004. Epub 2007 Sep 11.
To determine if percent surface area involvement (SAI) of tumor in endometrial cancer is predictive of lymph node metastasis.
A retrospective study was performed of all patients diagnosed with endometrial cancer at Magee Women's Hospital between January 1990 and December of 1995. Papillary serous and clear cell histologic subtypes were excluded. Pathology reports were reviewed for percent SAI, myometrial invasion, grade, histologic subtype, lymphovascular space invasion, and lymph node metastasis. Percent SAI was categorized into three groups: <35%, 35-80%, and >80%. The primary outcome variables were pelvic or periaortic lymph node metastasis. Univariate and multivariate analysis logistic regression models were used to determine predictors of nodal metastasis.
Of 558 patient records reviewed, 319 had lymph node dissections performed and 42 (13%) of those patients had positive lymph nodes. Two of 79 (3%) patients with <35% SAI had lymph node metastasis, 17 of 165 (10%) patients with 35-80% SAI had lymph node metastasis, and 23 of 75 (31%) patients with >80% SAI had lymph node metastasis. The percent SAI was significantly associated with lymph node metastasis (p<0.001). Multivariate logistic regression indicated that for patients with >80% SAI, the odds of having lymph node metastasis were 10.8 times (CI 1.3-90.4) that for patients with similar tumor histology, grade, and invasion, but <35% SAI (p=0.03). A subset analysis of patients with superficial myometrial invasion was performed and 16% of patients with <50% myometrial invasion and >80% SAI had positive lymph nodes, while only 1.4% of patients with <50% myometrial invasion and <35% SAI had positive lymph nodes (p=0.02).
Our analysis indicates that percent SAI is an independent risk factor for lymph node metastasis. Furthermore, assessing SAI with myometrial invasion gives a more accurate prediction of lymph node metastasis than myometrial invasion alone. This becomes clinically relevant when assessing risk factors for lymph node metastasis intraoperatively.
确定子宫内膜癌肿瘤的表面积累及百分比（SAI）是否可预测淋巴结转移。
对1990年1月至1995年12月期间在梅杰妇女医院诊断为子宫内膜癌的所有患者进行回顾性研究。排除乳头状浆液性和透明细胞组织学亚型。查阅病理报告以获取SAI百分比、肌层浸润、分级、组织学亚型、淋巴管间隙浸润和淋巴结转移情况。SAI百分比分为三组：<35%、35 - 80%和>80%。主要结局变量为盆腔或腹主动脉旁淋巴结转移。使用单因素和多因素分析逻辑回归模型来确定淋巴结转移的预测因素。
在查阅的558份患者记录中，319例患者进行了淋巴结清扫，其中42例（13%）患者淋巴结阳性。SAI<35%的79例患者中有2例（3%）发生淋巴结转移，SAI为35 - 80%的165例患者中有17例（10%）发生淋巴结转移，SAI>80%的75例患者中有23例（31%）发生淋巴结转移。SAI百分比与淋巴结转移显著相关（p<0.001）。多因素逻辑回归表明，对于SAI>80%的患者，发生淋巴结转移的几率是肿瘤组织学、分级和浸润情况相似但SAI<35%的患者的10.8倍（CI 1.3 - 90.4）（p = 0.03）。对浅肌层浸润患者进行了亚组分析，肌层浸润<50%且SAI>80%的患者中有16%淋巴结阳性，而肌层浸润<50%且SAI<35%的患者中只有1.4%淋巴结阳性（p = 0.02）。
我们的分析表明，SAI百分比是淋巴结转移的独立危险因素。此外，将SAI与肌层浸润一起评估比单独评估肌层浸润能更准确地预测淋巴结转移。在术中评估淋巴结转移的危险因素时，这具有临床相关性。
