Boyraz Gokhan, Salman Mehmet Coskun, Gultekin Murat, Basaran Derman, Cagan Murat, Ozgul Nejat, Yuce Kunter
*Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, and †Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Int J Gynecol Cancer. 2017 Mar;27(3):486-492. doi: 10.1097/IGC.0000000000000919.
The study aims to investigate effect of tumor size on lymphatic spread in patients with low-risk endometrial cancer (EC).
This study included patients with EC who underwent staging surgery with systematic lymphadenectomy between 2002 and 2015 at the Hacettepe University Hospital. Patients with grade 1 or 2 endometrioid type tumor who had 50% or lower myometrial invasion were included. Patients who had no myometrial invasion or had uterine high-risk features (nonendometrioid histology, grade 3, and deep myometrial invasion) were excluded.
The study group consisted of 191 patients, and the mean age of the patients was 57.8 years. Of these patients, 124 (64.9%) had tumor size of more than 2 cm and 67 (35.1%) had tumor size of 2 cm or less. Lymph node metastasis was detected in 12 (9.7%) of the 124 patients with tumor size of more than 2 cm. On the other hand, none of the 67 patients (0%) with tumor size of 2 cm or less was found to have lymphatic involvement. Of the factors analyzed for correlation with lymph node metastasis in patients with low-risk EC, the presence of lymphovascular space invasion (LVSI) and primary tumor size were found to be significant predictors of lymphatic spread in univariate analysis (P < 0.001 and P = 0.009, respectively). In multivariate analysis, tumor size (odds ratio, 6.86; 95% confidence interval, 1.007-infinite; P < 0.05) and LVSI (odds ratio, 14.261; 95% confidence interval, 3.4-59.6; P < 0.001) were 2 independent predictors associated with lymphatic involvement.
Our trial supports that tumor size of more than 2 cm and LVSI are 2 independent factors for lymph node metastasis in patients with low-risk EC. Both factors can be used together to select patients with traditional low-risk histologic features who would absolutely benefit from lymph node dissection.
本研究旨在探讨肿瘤大小对低风险子宫内膜癌（EC）患者淋巴转移的影响。
本研究纳入了2002年至2015年间在哈杰泰佩大学医院接受分期手术并行系统性淋巴结清扫术的EC患者。纳入1级或2级子宫内膜样型肿瘤且肌层浸润率为50%或更低的患者。排除无肌层浸润或具有子宫高风险特征（非子宫内膜样组织学、3级和深层肌层浸润）的患者。
研究组由191例患者组成，患者的平均年龄为57.8岁。在这些患者中，124例（64.9%）肿瘤大小超过2 cm，67例（35.1%）肿瘤大小为2 cm或更小。在124例肿瘤大小超过2 cm的患者中，12例（9.7%）检测到淋巴结转移。另一方面，67例肿瘤大小为2 cm或更小的患者中无一例（0%）发现有淋巴受累。在分析的与低风险EC患者淋巴结转移相关的因素中，在单因素分析中，淋巴管间隙浸润（LVSI）的存在和原发肿瘤大小被发现是淋巴转移的重要预测因素（分别为P < 0.001和P = 0.009）。在多因素分析中，肿瘤大小（比值比，6.86；95%置信区间，1.007 - 无穷大；P < 0.05）和LVSI（比值比，14.261；95%置信区间，3.4 - 59.6；P < 0.001）是与淋巴受累相关的2个独立预测因素。
我们的试验支持肿瘤大小超过2 cm和LVSI是低风险EC患者淋巴结转移的2个独立因素。这两个因素可共同用于选择那些绝对能从淋巴结清扫术中获益的具有传统低风险组织学特征的患者。
