Ivanov S, Tomov S
Akush Ginekol (Sofiia). 2009;48(3):14-9.
Our aim was to research and evaluate for 10 years period the most important prognostic factors, related and determining the choice of suitable type of radical surgical treatment. It was performed in diagnosed endometrial cancer patients.
We researched 460 patients with endometrial cancer for 10 years period. All of them were operated by radical programme. We evaluated the following prognostic factors: stage, age, histological type, tumor grading, invasion of the tumor in myometrium, tumor volume, peritoneal cytology, LVSI, hormonal receptor status, nuclear grading, DNA--ploidy, the extent of the lymph node dissection (number of lymph nodes) and specific genetic alterations connected with endometrial cancers.
The surgical determined stage was the most important prognostic factor. The age was independent factor. The histological type was very important prognostic factor--the endometrioid cancers were with better survival rate (89%) in comparison with the rare papillary-serous and clear cell cancers (30%). The tumor grading and myometrical invasion had a very important prognostic significance. When the patients were with grade 3 and infiltration in the outer third of myometrium--the positive pelvic lymph nodes were 30% and the paraaortal--20%. The tumor volume according to us is an independent prognostic factor. When the diameter of the tumor was less than 2 cm--the metastases in the lymph nodes were 3% and when the diameter was more than 2 cm--the metastases were 18%. If the tumor volume occupied the whole endometrial cavity and invasion in myometrium was deep, we had 40% metastases in the lymph nodes. The peritoneal cytology had a relative risk. The LVSI was independent prognostic factor. The ER and PR were independent prognostic factors. The nuclear grading--according to our results is a significant prognostic factor. The aneuploidy was the strongest independent factor for bad survival after age and stage. The extent (the volume) of the lymph node dissection was considered as an independent prognostic factor. In type I endometrioid endometrical cancers we evaluated the microsatelite instability and mutations in PIEN, pikCA, etc. The non estrogen related type 2 nonendometrioid endometrial cancers (serous, clear cell) showed mutations in P53 gene and chromosomal instability.
Researching and evaluating the prognostic factors for endometrial cancers, we wanted to help and determine the best surgical treatment (the extent, the need for pelvic and paraaortal lymph node dissection).
The radical surgical treatment with lymph node dissection gives better survival rate, as in low risky groups as well in high risky groups of endometrial cancers. The extent (the number of the lymph nodes) is an independent prognostic factor.
我们的目的是对10年间最重要的预后因素进行研究和评估，这些因素与选择合适的根治性手术治疗类型相关并起决定性作用。研究对象为已确诊的子宫内膜癌患者。
我们对460例子宫内膜癌患者进行了为期10年的研究。所有患者均接受了根治性手术方案。我们评估了以下预后因素：分期、年龄、组织学类型、肿瘤分级、肿瘤浸润肌层情况、肿瘤体积、腹腔细胞学检查、淋巴血管间隙浸润（LVSI）、激素受体状态、核分级、DNA倍体、淋巴结清扫范围（淋巴结数量）以及与子宫内膜癌相关的特定基因改变。
手术确定的分期是最重要的预后因素。年龄是独立因素。组织学类型是非常重要的预后因素——子宫内膜样癌的生存率较好（89%），相比之下，少见的乳头状浆液性癌和透明细胞癌的生存率为30%。肿瘤分级和肌层浸润具有非常重要的预后意义。当患者为3级且浸润至肌层外三分之一时，盆腔淋巴结阳性率为30%，腹主动脉旁淋巴结阳性率为20%。我们认为肿瘤体积是一个独立的预后因素。当肿瘤直径小于2cm时，淋巴结转移率为3%；当直径大于2cm时，转移率为18%。如果肿瘤体积占据整个子宫内膜腔且肌层浸润较深，我们观察到淋巴结转移率为40%。腹腔细胞学检查具有相对风险。LVSI是独立的预后因素。雌激素受体（ER）和孕激素受体（PR）是独立的预后因素。根据我们的结果，核分级是一个重要的预后因素。非整倍体是仅次于年龄和分期的影响不良生存的最强独立因素。淋巴结清扫范围（体积）被视为一个独立的预后因素。在I型子宫内膜样癌中，我们评估了微卫星不稳定性以及PIEN、pikCA等基因的突变情况。非雌激素相关的II型非子宫内膜样癌（浆液性、透明细胞癌）表现出P53基因的突变和染色体不稳定。
在研究和评估子宫内膜癌的预后因素时，我们希望有助于确定最佳的手术治疗方案（范围、盆腔和腹主动脉旁淋巴结清扫的必要性）。
进行淋巴结清扫的根治性手术治疗能提高生存率，无论是在子宫内膜癌的低风险组还是高风险组。清扫范围（淋巴结数量）是一个独立的预后因素。
