Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Arch Gynecol Obstet. 2013 Dec;288(6):1391-7. doi: 10.1007/s00404-013-2913-x. Epub 2013 Jun 14.
To determine clinicopathological risk factors associated with lymph node metastasis in endometrial cancer (EC).
Clinicopathological data of patients who underwent comprehensive surgical staging for clinical early stage EC between 2001 and 2010 at Hacettepe University Hospital was retrospectively reviewed.
Two hundred and sixty-one patients were included. There were 26 patients (10.0%) with lymph node metastasis. Of these, 14 (5.4%) had pelvic lymph node metastasis, 8 (3.1%) had both pelvic and paraaortic lymph node metastasis, and 4 (1.5%) had isolated paraaortic metastasis. Univariate analysis revealed tumor size >2 cm, type II cancer, grade III histology, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, and presence of lymphovascular space involvement (LVSI) as significant clinicopathological factors associated with retroperitoneal lymph node metastasis. For paraaortic metastasis either isolated or with pelvic lymph node metastasis, significant factors were grade III disease, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, pelvic lymph node metastasis, and presence of LVSI. The only factor associated with isolated paraaortic lymph node metastasis was LVSI. Multivariate analysis revealed LVSI as the only independent factor for both retroperitoneal and paraaortic lymph node metastasis (odds ratio 14.9; 95% confidence interval 3.8-59.0; p < 0.001, and odds ratio 20.9; 95% confidence interval 1.9-69.9; p = 0.013, respectively).
Lymphovascular space involvement is the sole predictor of lymph node metastasis in EC. Therefore, LVSI status should be requested from the pathologist during frozen examination whenever possible to consider when a decision to perform or omit lymphadenectomy is made.
确定与子宫内膜癌（EC）淋巴结转移相关的临床病理危险因素。
回顾性分析 2001 年至 2010 年在哈塞特佩大学医院接受全面手术分期的临床早期 EC 患者的临床病理数据。
共纳入 261 例患者。26 例（10.0%）发生淋巴结转移。其中，14 例（5.4%）有盆腔淋巴结转移，8 例（3.1%）有盆腔和腹主动脉旁淋巴结转移，4 例（1.5%）有孤立性腹主动脉旁转移。单因素分析显示肿瘤大小>2cm、II 型癌、组织学 III 级、宫颈间质浸润、深部肌层浸润、阳性腹膜细胞学、附件受累、浆膜受累和存在淋巴管血管间隙浸润（LVSI）与腹膜后淋巴结转移相关。对于孤立性或伴有盆腔淋巴结转移的腹主动脉转移，显著因素为 III 级疾病、宫颈间质浸润、深部肌层浸润、阳性腹膜细胞学、附件受累、浆膜受累、盆腔淋巴结转移和存在 LVSI。唯一与孤立性腹主动脉淋巴结转移相关的因素是 LVSI。多因素分析显示 LVSI 是腹膜后和腹主动脉淋巴结转移的唯一独立因素（优势比 14.9；95%置信区间 3.8-59.0；p<0.001，和优势比 20.9；95%置信区间 1.9-69.9；p=0.013）。
淋巴管血管空间浸润是 EC 淋巴结转移的唯一预测因子。因此，在进行冰冻检查时，病理科应尽可能要求 LVSI 状态，以便在决定是否进行或省略淋巴结切除术时考虑。
