Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Int J Clin Oncol. 2017 Oct;22(5):937-944. doi: 10.1007/s10147-017-1139-5. Epub 2017 May 18.
The purpose of this study was to determine the risk factors for paraaortic lymph node (LN) metastasis in endometrial cancer (EC) patients who underwent comprehensive surgical staging.
A total of 641 women with EC (endometrioid, non-endometrioid, or mixed histology) who underwent comprehensive surgical staging including pelvic and paraaortic LN dissection between 2008 and 2016 were included in this retrospective study. Patient data were analyzed with respect to paraaortic LN involvement, and predictive factors for paraaortic LN metastasis were investigated.
Lymph node metastasis was detected in 90 (14%) patients, isolated pelvic LN metastasis in 28 (4.3%), isolated paraaortic LN metastasis in 15 (2.3%), and both pelvic and paraaortic LN metastasis in 47 (7.3%) women, respectively. Univariate analysis showed that the risk of paraaortic LN metastasis significantly increased in patients with non-endometrioid histology, age greater than 60 years, grade 3 tumor, deep myometrial invasion, lymphovascular space invasion (LVSI), primary tumor diameter (≥2 cm), cervical stromal invasion, adnexal involvement, serosal invasion, pelvic LN involvement, two or more positive pelvic LNs, and positive peritoneal cytology (p < 0.05). At the end of multivariate analysis, the presence of LVSI [odds ratio (OR), 4.8; 95% confidence interval (CI), 1.25-18.2; p = 0.022] and pelvic LN metastasis (OR, 18.8; 95% CI, 5.7-61.6; p < 0.001) remained as independent risk factors for paraaortic LN involvement in women with EC.
The presence of LVSI and pelvic LN involvement appear to be independent risk factors for paraaortic LN metastasis in patients with EC. LVSI may be considered as a routine pathological parameter during frozen section analysis in women with EC undergoing surgery.
本研究旨在确定接受全面手术分期的子宫内膜癌（EC）患者发生腹主动脉旁淋巴结（LN）转移的危险因素。
本回顾性研究纳入了 2008 年至 2016 年间接受包括盆腔和腹主动脉旁 LN 清扫术在内的全面手术分期的 641 例 EC（子宫内膜样、非子宫内膜样或混合组织学）患者。分析患者的腹主动脉旁 LN 受累情况，并探讨腹主动脉旁 LN 转移的预测因素。
90 例（14%）患者检测到淋巴结转移，28 例（4.3%）为单纯盆腔 LN 转移，15 例（2.3%）为单纯腹主动脉旁 LN 转移，47 例（7.3%）为盆腔和腹主动脉旁 LN 均转移。单因素分析显示，非子宫内膜样组织学、年龄>60 岁、G3 肿瘤、深肌层浸润、脉管间隙浸润（LVSI）、原发肿瘤直径（≥2cm）、宫颈间质浸润、附件受累、浆膜侵犯、盆腔 LN 受累、两个或更多阳性盆腔 LN 以及阳性腹腔细胞学的患者发生腹主动脉旁 LN 转移的风险显著增加（p<0.05）。多因素分析结束时，LVSI 的存在[比值比（OR），4.8；95%置信区间（CI），1.25-18.2；p=0.022]和盆腔 LN 转移（OR，18.8；95%CI，5.7-61.6；p<0.001）仍然是 EC 患者腹主动脉旁 LN 受累的独立危险因素。
LVSI 的存在和盆腔 LN 受累似乎是 EC 患者发生腹主动脉旁 LN 转移的独立危险因素。在接受手术的 EC 患者中，LVSI 可能被视为冰冻切片分析中的常规病理参数。
