Türkmen Osman, Başaran Derman, Karalök Alper, Cömert Kimyon Günsu, Taşçı Tolga, Üreyen Işın, Tulunay Gökhan, Turan Taner
Clinic of Gynecologic Oncology, Gaziantep Cengiz Gökçek Obstetrics and Children’s Hospital, Gaziantep, Turkey
Clinic of Gynecologic Oncology, University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Ankara, Turkey
J Turk Ger Gynecol Assoc. 2018 Nov 15;19(4):201-205. doi: 10.4274/jtgga.2017.0152. Epub 2018 Mar 28.
To evaluate the prognostic effect of isolated paraaortic lymph node metastasis in endometrial cancer (EC).
This retrospective study included patients with FIGO 2009 stage IIIC2 disease due to isolated paraaortic lymph node metastasis (LNM). Patients with sarcomatous histology, synchronous gynecologic cancers and patients with concurrent pelvic lymph node metastases or patients that have intraabdominal tumor spread were excluded. Kaplan-Meier method was used for calculation of progression free survival (PFS) and overall survival.
One thousand six hundred and fourteen patients were operated for EC during study period. Nine hundred and sixty-one patients underwent lymph node dissection and 25 (2.6%) were found to have isolated LNM in paraaortic region and these constituted the study cohort. Twenty (80%) patients had endometrioid EC. Median number of retrieved lymph nodes from pelvic region and paraaortic region was 21.5 (range: 5-41) and 34.5 (range: 1-65), respectively. Median number of metastatic paraaortic nodes was 1 (range: 1-32). The median follow-up time was 15 months (range 5-94). Seven (28%) patients recurred after a median of 20 months (range, 3-99) from initial surgery. Three patients recurred only in pelvis, one patient had upper abdominal spread and 3 had isolated extraabdominal recurrence. Involvement of uterine serosa, positive peritoneal cytology and presence of adnexal metastasis were significantly associated with diminished PFS (p<0.05).
The presence of serosal involvement or adnexal involvement is as important as gross peritoneal spread and is related with poor survival in patients with isolated paraaortic nodal spread in EC. Chemotherapy should be the mainstay of treatment in this patient cohort which may eradicate systemic tumor spread.
评估子宫内膜癌（EC）中孤立性腹主动脉旁淋巴结转移的预后影响。
本回顾性研究纳入因孤立性腹主动脉旁淋巴结转移（LNM）导致的国际妇产科联盟（FIGO）2009年IIIC2期疾病患者。排除肉瘤组织学患者、同步性妇科癌症患者以及合并盆腔淋巴结转移或腹腔内肿瘤播散的患者。采用Kaplan-Meier法计算无进展生存期（PFS）和总生存期。
研究期间1614例患者接受了EC手术。961例患者进行了淋巴结清扫，其中25例（2.6%）被发现腹主动脉旁区域存在孤立性LNM，这些患者构成了研究队列。20例（80%）患者为子宫内膜样EC。盆腔区域和腹主动脉旁区域回收淋巴结的中位数分别为21.5个（范围：5 - 41个）和34.5个（范围：1 - 65个）。腹主动脉旁转移淋巴结的中位数为1个（范围：1 - 32个）。中位随访时间为15个月（范围5 - 94个月）。7例（28%）患者在初次手术后中位20个月（范围3 - 99个月）复发。3例患者仅在盆腔复发，1例患者出现上腹部播散，3例出现孤立性腹外复发。子宫浆膜受累、阳性腹腔细胞学检查和附件转移与PFS降低显著相关（p<0.05）。
浆膜受累或附件受累与肉眼可见的腹膜播散同样重要，并且与EC中孤立性腹主动脉旁淋巴结播散患者的不良生存相关。化疗应作为该患者队列的主要治疗手段，这可能根除全身肿瘤播散。
