Baiocchi Glauco, Faloppa Carlos Chaves, Mantoan Henrique, Camarço Willian Ricardo, Badiglian-Filho Levon, Kumagai Lillian Yuri, De Brot Louise, da Costa Alexandre Andre Balieiro Anastacio
Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil.
J Surg Oncol. 2017 Aug;116(2):220-226. doi: 10.1002/jso.24651. Epub 2017 May 8.
To determine the predictive factors of para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and recommend a subgroup of patients who can safely forgo PALN dissection.
We analyzed a series of 255 patients who were at risk of lymph node metastasis and treated from June 2007 to June 2015. All patients underwent systematic pelvic and para-aortic lymphadenectomy.
The median number of pelvic lymph nodes (PLN) and PALNs that were resected was 33 and 15, respectively. Fifty (19.6%) patients had LN metastasis-43 (16.9%) pelvic, 28 (11%) para-aortic, 21 (8.2%) pelvic and para-aortic, and 7 (2.7%) isolated PALN metastasis. PALN metastasis was significantly associated with PLN metastasis, the presence of lymphovascular space invasion, deep myometrial invasion (MI), and histological grade 3. In the multivariate analysis, only pelvic LN metastasis and deep MI remained independent risk factors of PALN metastasis. For patients without LN enlargement ± adnexal metastasis, when deep MI and PLN metastasis were absent, the risk of PALM was 0.8%.
Our series supports that PALN metastasis is a rare event in the absence of PLN metastasis and that most patients can safely forego PALN dissection. This subgroup can be identified by the combined absence of PLN metastasis and deep MI.
确定子宫内膜癌（EC）腹主动脉旁淋巴结（PALN）转移的预测因素，并推荐一组可安全免除PALN清扫术的患者亚组。
我们分析了2007年6月至2015年6月期间一系列有淋巴结转移风险并接受治疗的255例患者。所有患者均接受了系统性盆腔和腹主动脉旁淋巴结清扫术。
切除的盆腔淋巴结（PLN）和PALN的中位数分别为33个和15个。50例（19.6%）患者发生淋巴结转移——43例（16.9%）盆腔转移，28例（11%）腹主动脉旁转移，21例（8.2%）盆腔和腹主动脉旁转移，7例（2.7%）孤立性PALN转移。PALN转移与PLN转移、淋巴管间隙浸润、子宫肌层深部浸润（MI）和组织学3级显著相关。在多变量分析中，只有盆腔LN转移和子宫肌层深部浸润仍然是PALN转移的独立危险因素。对于无LN肿大±附件转移的患者，若不存在子宫肌层深部浸润和PLN转移，则PALM风险为0.8%。
我们的系列研究支持，在没有PLN转移的情况下，PALN转移是一种罕见事件，大多数患者可以安全地免除PALN清扫术。该亚组可通过PLN转移和子宫肌层深部浸润均不存在来确定。
