Alay Ismail, Turan Taner, Ureyen Isin, Karalok Alper, Tasci Tolga, Ozfuttu Ahmet, Kose M Faruk, Tulunay Gokhan
Gynecologic Oncology Department, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Etlik Street, 06010, Kecioren, Ankara, Turkey.
Pathol Oncol Res. 2015 Jul;21(3):803-10. doi: 10.1007/s12253-014-9893-4. Epub 2015 Jan 7.
We aimed to evaluate para-aortic metastases relative to the level of inferior mesenteric artery (IMA) and to discuss the clinico-pathological features of these patients. A total of 204 patients who underwent systematic pelvic and para-aortic lymphadenectomy up to the level of renal veins for endometrial cancer between January 2007 and August 2013 were included in this study. Of these 204 patients, 44 (21.6 %) had lymph node involvement. From a total of 27 patients with paraaortic lymph node (PALN) metastasis, 11 had only supramesenteric and 4 had only inframesenteric nodal involvement, while 12 had both supramesenteric and inframesenteric metastases. Supramesenteric lymph node metastases were detected in 85.2 % of patients who have para-aortic metastases and in 11.3 % of all patients. Additionally, 5 patients had only supramesenteric lymphatic metastasis. The surgico-pathological characteristics of patients with isolated supramesenteric and inframesenteric metastasis were similar. However, the patients with lymphatic spread in both regions were found to have pelvic lymphatic metastasis and cervical invasion more commonly compared to patients with only supramesenteric or only inframesenteric metastasis. The site of metastatic lymph nodes wasn't associated with the likelihood and site of recurrence. Lymphadenectomy should be performed up to the level of renal vein in case of the presence of indication for lymphadenectomy in patients with endometrial cancer. Additionally, it is not possible to predict the patients with supramesenteric lymph node involvement by tumor grade, histological type and myometrial invasion.
我们旨在评估相对于肠系膜下动脉（IMA）水平的腹主动脉旁转移情况，并探讨这些患者的临床病理特征。本研究纳入了2007年1月至2013年8月期间因子宫内膜癌接受系统性盆腔及腹主动脉旁淋巴结清扫至肾静脉水平的204例患者。在这204例患者中，44例（21.6%）有淋巴结受累。在总共27例有腹主动脉旁淋巴结（PALN）转移的患者中，11例仅有肠系膜上淋巴结转移，4例仅有肠系膜下淋巴结转移，而12例既有肠系膜上淋巴结转移又有肠系膜下淋巴结转移。在有腹主动脉旁转移的患者中，85.2%检测到肠系膜上淋巴结转移，在所有患者中为11.3%。此外，5例患者仅有肠系膜上淋巴结转移。孤立的肠系膜上和肠系膜下转移患者的手术病理特征相似。然而，与仅有肠系膜上或仅有肠系膜下转移的患者相比，两个区域均有淋巴转移的患者更常出现盆腔淋巴转移和宫颈浸润。转移淋巴结的部位与复发的可能性和部位无关。对于有子宫内膜癌且有淋巴结清扫指征的患者，应进行至肾静脉水平的淋巴结清扫。此外，无法通过肿瘤分级、组织学类型和肌层浸润来预测有肠系膜上淋巴结受累的患者。
