Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital, Gynecologic Oncology Division, Ankara, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):274-9. doi: 10.1016/j.ejogrb.2011.04.031. Epub 2011 Jun 12.
The purpose of this study was to determine the histopathologic risk factors for pelvic lymph node (PLN) and para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and to identify in which patients PALN dissection should be performed.
A total of 204 consecutive patients, with EC and underwent systematic pelvic and para-aortic lymphadenectomy extending to the renal vessels, were studied retrospectively. Statistical significance between risk factors was examined using multivariant logistic regression analysis.
Cell type, depth of myometrial invasion and tumor size were found to be independently related to PLN metastasis. PLN metastasis in any site and lymphovascular invasion (LVSI) were independent prognostic factors for predicting PALN metastasis. The sensitivity, specificity and the NPV of PLN metastasis for detecting PALN metastasis were 80.8%, 89.3% and 97%, respectively. Furthermore, the 204 patients were divided into two groups according to the presence of one of these following factors: (1) non-endometrioid cell type, (2) PLN metastasis, (3) LVSI, (4) adnexal metastasis and (5) serosal involvement. Among these 204 patients, 104 had one or more of these factors (group A), and 100 patients had none of these factors (group B). PALN metastasis was significantly greater in group A, compared to group B. The sensitivity and the NPV of these combined prognostic factors for predicting PALN metastasis were 96.2% and 99%, respectively.
Presence of non-endometrioid cell type, PLN metastasis, LVSI, adnexal metastasis or serosal involvement diagnosed by frozen section (FS) seem to be poor prognostic factor for PALN metastasis in EC. Also, PALN dissection should be extended to the level of the renal vessels in all patients who will undergo PALN dissection, due to frequent involvement of the supramesenterial region.
本研究旨在确定子宫内膜癌（EC）盆腔淋巴结（PLN）和腹主动脉旁淋巴结（PALN）转移的组织病理学危险因素，并确定在哪些患者中应进行 PALN 解剖。
回顾性研究了 204 例连续接受系统盆腔和腹主动脉旁淋巴结切除术（延伸至肾血管水平）的 EC 患者。使用多变量逻辑回归分析检查危险因素之间的统计学意义。
细胞类型、肌层浸润深度和肿瘤大小被发现与 PLN 转移独立相关。任何部位的 PLN 转移和脉管内肿瘤侵犯（LVSI）是预测 PALN 转移的独立预后因素。PLN 转移对 PALN 转移的敏感性、特异性和阴性预测值分别为 80.8%、89.3%和 97%。此外，根据以下因素之一将 204 例患者分为两组：（1）非子宫内膜样细胞类型，（2）PLN 转移，（3）LVSI，（4）附件转移和（5）浆膜累及。在这 204 例患者中，有 104 例患者有一个或多个这些因素（A 组），100 例患者无这些因素（B 组）。与 B 组相比，A 组的 PALN 转移明显更多。这些联合预后因素对预测 PALN 转移的敏感性和阴性预测值分别为 96.2%和 99%。
冷冻切片（FS）诊断出的非子宫内膜样细胞类型、PLN 转移、LVSI、附件转移或浆膜累及似乎是 EC 中 PALN 转移的不良预后因素。此外，由于肠系膜上区经常受累，所有行 PALN 解剖的患者均应将 PALN 解剖延伸至肾血管水平。
