School of Medicine, University of Queensland, Brisbane, Australia.
Int J Gynecol Cancer. 2010 Oct;20(7):1217-21. doi: 10.1111/igc.0b013e3181ef0a31.
Concurrent uterine lesions or an irregular endomyometrial junction can make accurate assessment of depth of myometrial invasion (DOI) and percentage of myometrial invasion (%MI) difficult, leading to patients being staged and or treated suboptimally. An alternative measurement, known as the tumor-free distance (TFD), which measures the distance between maximal myometrial invasion and the uterine serosa, has been proposed. Previous studies comparing the predictive abilities of DOI and TFD were underpowered and inconclusive. Our objective was to compare TFD, DOI, and %MI as predictors for lymph node involvement in surgically staged endometrial cancer patients.
Patients with endometrioid adenocarcinoma of the endometrium treated between January 1997 and December 2007 were included. Tumor-free distance, DOI, and %MI were evaluated along with other pathological variables to determine their predictive ability for nodal involvement. Depth of myometrial invasion was measured between the endomyometrial junction and the maximal myometrial invasion. Tumor-free distance was calculated by subtracting the DOI from myometrial thickness (MT). Percentage MI was derived by dividing DOI by MT and expressed as a percentage of MT invaded. These 3 variables were transformed to z scores, and their ability to predict nodal involvement was compared.
A total of 338 patients were eligible for analysis. Mean (SD) MT was 18.7 (5.9) mm. Median DOI was 6 mm, and median TFD was 10.3 mm. On univariate analysis, all 3 variables showed significant associations with nodal involvement. On multivariate analysis, after adjusting for lymphovascular space invasion, cervical involvement, serosal/adnexal involvement, grade, %MI, and TFD, DOI retained its statistical significance along with lymphovascular space invasion and cervical involvement.
Depth of myometrial invasion predicts nodal involvement independently when compared with TFD.
同时存在子宫内病变或子宫内膜交界不规则会使准确评估肌层浸润深度（DOI）和肌层浸润百分比（%MI）变得困难，导致患者分期和/或治疗不充分。已提出一种替代测量方法，称为无肿瘤距离（TFD），它测量最大肌层浸润与子宫浆膜之间的距离。先前比较 DOI 和 TFD 预测能力的研究样本量不足且结论不一致。我们的目的是比较 TFD、DOI 和 %MI 作为预测子宫内膜癌手术分期患者淋巴结受累的指标。
纳入 1997 年 1 月至 2007 年 12 月期间治疗的子宫内膜样腺癌患者。评估 TFD、DOI 和 %MI 以及其他病理变量，以确定它们对淋巴结受累的预测能力。肌层浸润深度在子宫内膜交界与最大肌层浸润之间测量。通过从肌层厚度（MT）中减去 DOI 来计算 TFD。%MI 通过将 DOI 除以 MT 并表示为 MT 浸润的百分比来计算。将这 3 个变量转换为 z 分数，并比较它们预测淋巴结受累的能力。
共有 338 名患者符合分析条件。平均（SD）MT 为 18.7（5.9）mm。中位 DOI 为 6mm，中位 TFD 为 10.3mm。单变量分析显示，所有 3 个变量均与淋巴结受累显著相关。多变量分析显示，在校正脉管侵犯、宫颈受累、浆膜/附件受累、分级、%MI 和 TFD 后，DOI 与脉管侵犯和宫颈受累一样具有统计学意义。
与 TFD 相比，DOI 独立预测淋巴结受累。
