Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Gynecol Oncol. 2019 Oct;155(1):27-33. doi: 10.1016/j.ygyno.2019.07.016. Epub 2019 Jul 24.
To assess risk factors for lymph node involvement in patients with endometrial cancer and a body-mass index (BMI) ≥30 kg/m.
A retrospective analysis was performed of obese patients diagnosed with endometrial carcinoma between 2007 and 2015, treated in a single center in Montreal. Preoperative variables evaluated were age, BMI, parity, and preoperative ASA score, grade, CA-125 and histology. Odds ratios (OR) and hazard ratios (HR) and their respective 95% confidence intervals (95%CI) were calculated using multivariable logistic regression and Cox proportional hazard models.
The study included 230 women with BMI ≥30, 223 (97.0%) had complete staging. Pelvic lymph node involvement was detected in 26 patients (11.3%). Sentinel node detection and pelvic lymph node dissection decreased with increasing BMI (adjusted OR 0.86, 95%CI 0.76-0.97 and 0.76, 95%CI 0.59-0.96, respectively, per 1 kg/m increment). Pelvic lymph node involvement was inversely correlated with BMI (adjusted OR 0.88, 95%CI 0.79-0.99) and present in 16/85 (18.8%), 6/56 (10.7%), and 4/82 (4.9%) of patients with a BMI of 30.0-34.9, 35.0-39.9, and ≥40.0 kg/m, respectively. Preoperative CA-125 was associated with lymph node involvement (adjusted OR 2.77, 95%CI 1.62-4.73, per quartile increment).
Pelvic lymph node dissection might be omitted in selected cases of morbidly obese patients with failed sentinel nodes mapping and a low CA-125.
评估体质量指数（BMI）≥30kg/m2的子宫内膜癌患者发生淋巴结转移的风险因素。
回顾性分析了 2007 年至 2015 年期间在蒙特利尔的一家单中心确诊为子宫内膜癌的肥胖患者。评估的术前变量包括年龄、BMI、产次和术前 ASA 评分、分级、CA-125 和组织学。使用多变量逻辑回归和 Cox 比例风险模型计算比值比（OR）和风险比（HR）及其各自的 95%置信区间（95%CI）。
研究纳入了 230 名 BMI≥30 的女性，223 名（97.0%）患者完成了完整分期。26 名患者（11.3%）检测到盆腔淋巴结受累。随着 BMI 的增加，前哨淋巴结检测和盆腔淋巴结清扫的检出率降低（调整后的 OR 分别为 0.86、95%CI 0.76-0.97 和 0.76、95%CI 0.59-0.96，每增加 1kg/m）。盆腔淋巴结受累与 BMI 呈负相关（调整后的 OR 为 0.88、95%CI 0.79-0.99），在 BMI 为 30.0-34.9、35.0-39.9 和≥40.0kg/m2 的患者中，分别有 16/85（18.8%）、6/56（10.7%）和 4/82（4.9%）患者存在盆腔淋巴结受累。术前 CA-125 与淋巴结受累相关（调整后的 OR 为 2.77、95%CI 1.62-4.73，每四分位数递增）。
对于前哨淋巴结定位失败且 CA-125 水平较低的病态肥胖患者，可能可以省略盆腔淋巴结清扫术。
