Gynecologic Oncology Division, Zubeyde Hanim Women's Health Research and Teaching Hospital, Etlik Street, Kecioren, 06010 Ankara, Turkey.
Arch Gynecol Obstet. 2012 Apr;285(4):1119-24. doi: 10.1007/s00404-011-2030-7. Epub 2011 Sep 7.
The aim of this study was to evaluate whether the presence of cervical invasion has altered the site of lymph node (LN) metastasis in stage IIIC endometrial cancer (EC) patients.
Fourty-six patients who had systematic pelvic and para-aortic lymphadenectomy surgery for EC and staged as IIIC were included in the study. Patients with cervical invasion were defined as Group A and patients without cervical invasion were defined as Group B. The groups were compared according to surgical-pathologic characteristics. Chi-square and Annova table test were used to examine the effect of cervical invasion on LN metastasis.
The mean age of patients was 59 years (range 38-81) and tumor size was 47 mm (range 10-80). Twenty-three patients had cervical involvement (Group A) and 23 had no cervical metastasis (Group B). Groups were not different with regard to cell type, grade, depth of myometrial invasion, tumor size, adnexal involvement, peritoneal metastasis and lymphovascular space invasion. Among 46 patients obturator LN was the most involved site of LN metastasis, however, when there is cervical metastasis external iliac LN was found to be the most involved LN site. Patients without cervical invasion had 21.7% of external iliac LN metastasis while patients with cervical invasion had 60.9% of external iliac LN metastasis. Also, cervical invasion has increased the risk of pelvic LN and obturator LN involvement from 82.6 to 95.7% and 39.1 to 52.2%, respectively.
Cervical invasion may have an effect on lymphatic spread and change the site of metastatic LNs. Large prospective studies are needed to clarify the alteration of LN metastasis in cervix invaded EC patients.
本研究旨在评估 IIIC 期子宫内膜癌（EC）患者中宫颈浸润是否改变了淋巴结（LN）转移的部位。
本研究纳入了 46 例因 EC 接受系统性盆腔和腹主动脉旁淋巴结清扫术且分期为 IIIC 的患者。有宫颈浸润的患者定义为 A 组，无宫颈浸润的患者定义为 B 组。比较两组患者的手术病理特征。采用卡方检验和方差分析检验宫颈浸润对 LN 转移的影响。
患者的平均年龄为 59 岁（范围 38-81），肿瘤大小为 47mm（范围 10-80）。23 例患者有宫颈受累（A 组），23 例患者无宫颈转移（B 组）。两组患者在细胞类型、分级、肌层浸润深度、肿瘤大小、附件受累、腹膜转移和淋巴血管间隙浸润方面无差异。在 46 例患者中，闭孔 LN 是 LN 转移最常见的部位，但当有宫颈转移时，髂外 LN 是最常见的转移 LN 部位。无宫颈侵犯的患者髂外 LN 转移率为 21.7%，而有宫颈侵犯的患者髂外 LN 转移率为 60.9%。此外，宫颈侵犯使盆腔 LN 和闭孔 LN 受累的风险从 82.6%增加到 95.7%和 39.1%增加到 52.2%。
宫颈侵犯可能对淋巴扩散有影响，并改变转移性 LN 的部位。需要进行大型前瞻性研究以阐明宫颈侵犯的 EC 患者 LN 转移的改变。
