Sanci Muzaffer, Güngördük Kemal, Gülseren Varol, Karadeniz Tuğba, Kocaer Mustafa, Gungorduk Ozgu, Özdemir İsa A
Departments of Gynecologic Oncology (M.S.) Obstetrics and Gynecology (V.G., M.K., O.G.) Pathology (T.K.), Tepecik Education and Research Hospital, Izmir Department of Gynecologic Oncology, Muğla Sitki Koçman University Education and Research Hospital, Muğla (K.G.) Department of Gynecologic Oncology, Bakirköy Dr. Sadi Konuk Education and Research Hospital, İstanbul (I.A.O.), Turkey.
Int J Gynecol Pathol. 2018 Jan;37(1):17-21. doi: 10.1097/PGP.0000000000000370.
The aim of this study was to examine the associations between microcystic, elongated, and fragmented (MELF) pattern and other prognostic factors and lymph node involvement, disease-free survival, and overall survival (OS) using a case-control group consisting of grade I-II endometrioid endometrial carcinoma (EEC) patients with/without lymph node involvement. The files of the patients were searched electronically for all hysterectomy specimens with a diagnosis of grade I-II EEC of the uterine body from January 1, 2008 to July 31, 2014. Lymph node involvement was detected in 27 patients who were histologically diagnosed with grade I-II EEC, and these patients made up the case group. Using a dependent random sampling method, 28 grade I-II EEC patients without lymph node involvement were selected. According to multivariate regression analysis, lymphovascular space invasion [odds ratio, 23.5; 95% confidence interval (CI), 2.4-223.5] and MELF pattern (odds ratio, 13.3; 95% CI, 1.4-121.8) were significant predictors of lymph node involvement. There was recurrence in 15.8% of cases that showed a MELF pattern and in 19.4% of those that did not (P=0.738). According to Kaplan-Meier analysis, the MELF pattern revealed no significant differences in disease-free survival (hazard ratio, 1.0; 95% CI, 0.1-36.5), whereas the effect on OS was significant (hazard ratio, 2.2; 95% CI, 1.3-4.2). The presence of MELF pattern was a substantial risk factor for detecting lymph node involvement in patients with grade I-II EEC. The MELF pattern may be important for identifying which patients need staging surgery, in addition to its effect on the OS.
本研究的目的是，通过一个由有/无淋巴结受累的I-II级子宫内膜样子宫内膜癌（EEC）患者组成的病例对照组，研究微囊状、拉长状和碎片化（MELF）模式与其他预后因素以及淋巴结受累、无病生存期和总生存期（OS）之间的关联。通过电子检索2008年1月1日至2014年7月31日期间所有诊断为子宫体I-II级EEC的子宫切除标本患者档案。27例经组织学诊断为I-II级EEC且有淋巴结受累的患者构成病例组。采用相依随机抽样方法，选取28例无淋巴结受累的I-II级EEC患者。根据多因素回归分析，淋巴管间隙浸润（比值比，23.5；95%置信区间[CI]，2.4-223.5）和MELF模式（比值比，13.3；95%CI，1.4-121.8）是淋巴结受累的显著预测因素。显示MELF模式的病例中有15.8%复发，未显示该模式的病例中有19.4%复发（P=0.738）。根据Kaplan-Meier分析，MELF模式在无病生存期方面无显著差异（风险比，1.0；95%CI，0.1-36.5），而对总生存期的影响显著（风险比，2.2；95%CI，1.3-4.2）。MELF模式的存在是I-II级EEC患者检测到淋巴结受累的一个重要危险因素。除了对总生存期有影响外，MELF模式对于确定哪些患者需要进行分期手术可能也很重要。
