Lucic Nenad, Draganovic Dragica, Sibincic Sanja, Ecim-Zlojutro Vesna, Milicevic Snjezana
Clinic for Gynecology and Obstetrics, University Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina.
Clinic Medico S, Banjaluka, Bosnia and Herzegovina.
Med Arch. 2017 Oct;71(5):325-329. doi: 10.5455/medarh.2017.71.325-329.
The aim of this work is to show the importance of the depth of myometrium invasion, tumour size and lymphovascular invasion as prognostic factors in dissemination of lymphatic nodes at endometrial carcinoma (CE).
In the period from 2010 to 2015 at the University Clinic for Gynecology and Obstetrics in Banja Luka, 221 endometrial cancer surgeries were done (laparatomy 184-83%, laparascopy 37-16,74%). Patients who had uterus bleeding in peri/postmenopause or those whose endometrium thickness was bigger than 5 mm which was established by ultrasound, or those who had in their cavum uteri pathological (PH) diagnosis, underwent fractional curettage (FC) or hysteroscopy in order to obtain pathohistological endometrium diagnosis. Substances which were removed by fractional curettage, biopsy or by surgery were sent to patohystological analysis. We analysed the following factors: age (5 groups), histological grade (G) of tumour, depth of myometrial invasion (DIM), whether it is more or less than 50%, the size of the tumour (if it is bigger or smaller than 2 cm), positive or negative lymphovascular invasion (LVI), positive or negative pelvic lymph nodes (PLN).
Within histological type the endometrioid type CE 166 (75,11%) was most dominant. Adenocarcinoma of endometrium was present 25 (11,31%), serous CE 11 (4,97%) and clear cell KE 2 (0,90%). Dominant population with CE was over 60 years old 127 (57,46) of female patients. At G3 where DIM was <50% positive PLN were present 2 (3.92%), whereas if DIM was>50%, 6 (26,73%) patients with positive PLN were registred. Tumour size < 2 cm was found with 57 (25,79%) female patients with positive PLN 8 (14,03%), while 164 (74,20%) patients had tumours > 2 cm who had 21 (12,80) PLN metastases. At G1 when tumour was <2 cm, positive PLN had 3 patients (5,88), while when tumour was >2 cm, positive PLN were found at 6 patients (9,69%). At G3 whose size was <2 cm, positive PLN were found at 2 patients (16,66%), but when tumour was >2 cm, PLN metastases were more frequent, 6 (25,00%). Negative LVI was found with 168 patients (76,01%) whose PLN were positive 16 (9,52%), while positive LIV was with 53 patients (23,99%) of whom 14 had PLN metastases (26,41%). At G1 two patients had positive PLN (2,32%) with negative LVI, while with positive LVI, positive PLN were found at 3 patients (11,11%). At G3 having negative LVI positive PLN were found with 6 patients (24,00%), while if LIV was positive, the number of positive PLN were 6 (54,54%).
With low risk for lymphatic spread (DIM less than 50%, tumour size smaller than 2 cm and lack of LVI at G1 CE) we also encounter low metastasis rate of PLN. Diagnoses of this kind have an aim to lower the number of pelvic lymphadenectomies. With patients who have a high risk of lymphatic spread (myometrium invasion >50%, tumour size > 2cm, LVI present at G2 and G3) metastasis rate of PLN is high, therefore it is necessary to perform pelvic and paraaortic lymphadenectomy which lowers the mortality rate for more than 50% and at the same time patients get an absolute chance of 5-year survival period.
本研究旨在阐明子宫肌层浸润深度、肿瘤大小及淋巴管浸润作为子宫内膜癌（CE）淋巴结转移预后因素的重要性。
2010年至2015年期间，在巴尼亚卢卡大学妇产科诊所进行了221例子宫内膜癌手术（剖腹手术184例 - 83%，腹腔镜手术37例 - 16.74%）。对于围绝经期/绝经后子宫出血、超声检查显示子宫内膜厚度大于5mm或子宫腔病理（PH）诊断的患者，进行分段刮宫（FC）或宫腔镜检查以获得子宫内膜病理组织学诊断。通过分段刮宫、活检或手术切除的组织送去做病理组织学分析。我们分析了以下因素：年龄（5组）、肿瘤组织学分级（G）、子宫肌层浸润深度（DIM），是否大于或小于50%、肿瘤大小（是否大于或小于2cm）、淋巴管浸润阳性或阴性（LVI）、盆腔淋巴结阳性或阴性（PLN）。
在组织学类型中，子宫内膜样型CE 166例（75.11%）最为常见。子宫内膜腺癌25例（11.31%），浆液性CE 11例（4.97%），透明细胞KE 2例（0.90%）。CE患者的主要人群为60岁以上的女性患者127例（57.46%）。在G3级，当DIM<50%时，PLN阳性的患者有2例（3.92%），而当DIM>50%时，登记有6例（26.73%）PLN阳性患者。肿瘤大小<2cm的女性患者有57例（25.79%），其中PLN阳性的有8例（14.03%），而164例（74.20%）肿瘤>2cm的患者中有21例（12.80%）发生PLN转移。在G1级，当肿瘤<2cm时, PLN阳性的有3例（5.88%），而当肿瘤>2cm时，发现PLN阳性的有6例（9.69%）。在G3级，其大小<2cm时，发现PLN阳性的有2例（16.66%），但当肿瘤>2cm时，PLN转移更频繁，有6例（25.00%）。LVI阴性的患者有168例（76.01%），其中PLN阳性的有16例（9.52%），而LIV阳性的有53例（23.99%），其中14例有PLN转移（26.41%）。在G1级，2例患者LVI阴性但PLN阳性（2.32%），而LVI阳性时，发现PLN阳性的有3例（11.11%）。在G3级，LVI阴性时发现PLN阳性的有6例（24.00%），而如果LIV阳性，PLN阳性的数量为6例（54.54%）。
对于淋巴转移风险较低的情况（G1级CE时DIM小于50%、肿瘤大小小于2cm且无LVI），我们也发现PLN转移率较低。这类诊断旨在减少盆腔淋巴结清扫术的数量。对于淋巴转移风险较高的患者（子宫肌层浸润>50%、肿瘤大小>2cm、G2和G3级存在LVI），PLN转移率较高，因此有必要进行盆腔和腹主动脉旁淋巴结清扫术，这可将死亡率降低50%以上，同时患者获得5年生存期的绝对机会。
