Baiocchi Glauco, Clemente Ana Gabriela, Mantoan Henrique, da Costa Wilson Luiz, Bovolim Graziele, Guimaraes Andrea Paiva Gadelha, da Costa Alexandre Andre Balieiro Anastacio, De Brot Louise, Faloppa Carlos Chaves
Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil.
Ann Surg Oncol. 2020 Aug;27(8):2822-2826. doi: 10.1245/s10434-020-08261-8. Epub 2020 Feb 20.
To determine the risk factors related to adnexal involvement in endometrial cancer (EC) and its implications for ovarian preservation in young women.
We analyzed a series of 802 patients who were treated at AC Camargo Cancer Center from July 1991 to July 2017. Patients who had peritoneal or systemic dissemination (stage IV) were excluded. Chi square and Fisher's exact tests were used to analyze the correlations between categories and clinicopathological variables. Multivariate analysis was performed by logistic regression.
Forty-nine (6.2%) patients had adnexal involvement-43 (5.4%) ovarian and 24 (2.9%) tubal. After excluding the 14 (28%) cases with suspicious findings, 788 subjects were analyzed and adnexal involvement found in 35 (4.4%) cases. Adnexal involvement was statistically related to non-endometrioid histologies (12.6% vs. 3.1%; p < 0.001), lymph node metastasis (17% vs. 2.6%; p < 0.001), histological grade 3 tumors (9.4% vs. 2.1%; p < 0.001), presence of LVSI (14.2% vs. 2.4%; p < 0.001), and deep myometrial invasion (≥ 50%) (10.8% vs. 3.5%; p < 0.001). Although age younger than 45 years had higher risk of adnexal involvement, it was not statistically significant (8.9% vs. 4.2%; p = 0.13). Seven (14.2%) patients with adnexal involvement were aged < 45 years, 3 of whom (42.8%) had suspicious adnexal masses that were detected before surgery. Notably, all patients aged < 45 years and with adnexal involvement had at least 1 risk factor, such as presence of LVSI, grade 3 disease, node metastasis, or deep myometrial invasion. No patient with clinically normal ovaries and aged under 45 years, with endometrioid grades 1 and 2, superficial myometrial invasion, or node negativity had adnexal involvement.
Ovarian preservation may be considered for patients younger than 45 years old with low-risk EC (grades 1 and 2 tumors, absence of LVSI, and myometrial invasion < 50%).
确定与子宫内膜癌（EC）附件受累相关的危险因素及其对年轻女性卵巢保留的影响。
我们分析了1991年7月至2017年7月在AC卡马戈癌症中心接受治疗的802例患者。排除有腹膜或全身播散（IV期）的患者。采用卡方检验和Fisher精确检验分析类别与临床病理变量之间的相关性。通过逻辑回归进行多变量分析。
49例（6.2%）患者有附件受累，其中43例（5.4%）卵巢受累，24例（2.9%）输卵管受累。排除14例（28%）有可疑发现的病例后，对788名受试者进行分析，发现35例（4.4%）有附件受累。附件受累与非子宫内膜样组织学（12.6%对3.1%；p<0.001）、淋巴结转移（17%对2.6%；p<0.001）、组织学3级肿瘤（9.4%对2.1%；p<0.001）、存在淋巴血管间隙浸润（LVSI）（14.2%对2.4%；p<0.001）以及子宫肌层深层浸润（≥50%）（10.8%对3.5%；p<0.001）在统计学上相关。虽然年龄小于45岁的患者附件受累风险较高，但差异无统计学意义（8.9%对4.2%；p=0.13）。7例（14.2%）附件受累患者年龄<45岁，其中3例（42.8%）在手术前检测到可疑附件包块。值得注意的是，所有年龄<45岁且有附件受累的患者至少有1个危险因素，如存在LVSI、3级疾病、淋巴结转移或子宫肌层深层浸润。没有年龄在45岁以下、临床卵巢正常、子宫内膜样1级和2级、子宫肌层浅肌层浸润或淋巴结阴性的患者有附件受累。
对于年龄小于45岁、低风险子宫内膜癌（1级和2级肿瘤、无LVSI、子宫肌层浸润<50%）的患者，可以考虑保留卵巢。
