Department of Gynecologic Oncology, Bichat University Hospital, Paris, France; PREFERE Center, French referent center in conservative management of endometrial cancer, Bichat University Hospital, Paris, France.
Department of Gynecologic Oncology, Bichat University Hospital, Paris, France.
Gynecol Oncol. 2020 Apr;157(1):131-135. doi: 10.1016/j.ygyno.2020.02.021. Epub 2020 Mar 3.
Endometrial cancer (EC) is a rare condition in young women. The objective of this study was to evaluate the risk of pelvic lymph node (LN) metastasis in young women with EC who are candidates for conservative management.
Using the SEER database, a population-based analysis was conducted to identify women <45 years with grade 1, 2, or 3 endometrioid adenocarcinoma stage IA (FIGO 2009) who underwent pelvic lymphadenectomy with at least ten LNs removed. The LN macrometastases rate based on conventional histological diagnosis was analyzed according to tumor grade and myometrial invasion (MI) on final histology.
A cohort of 1284 women was analyzed. The LN metastasis rates were: 2/414 (0.5%) grade 1 EC without MI, 5/239 (2.1%) grade 2 or 3 EC without MI, 5/308 (1.6%) grade 1 EC with MI, and 14/323 (4.3%) grade 2 or 3 EC with MI. Tumor size was not correlated with LN metastasis probability.
Young patients eligible for conservative management have a low rate of LN macrometastasis, especially in stage IA without MI grade 1 EC. A systematic lymphadenectomy should not be performed in these patients. Prospective study evaluating the sentinel LN mapping in conservative management of EC could be performed to assess the LN micrometastasis rate.
子宫内膜癌（EC）在年轻女性中较为罕见。本研究旨在评估行保守治疗的年轻 EC 患者发生盆腔淋巴结（LN）转移的风险，这些患者适合行保守治疗。
利用 SEER 数据库，进行了一项基于人群的分析，以确定年龄<45 岁、FIGO 2009 分期为 IA 期、分级为 1、2 或 3 级的子宫内膜样腺癌、且至少切除 10 枚 LN 的患者。根据最终组织学检查中的肿瘤分级和肌层浸润（MI），对基于常规组织学诊断的 LN 宏转移率进行分析。
分析了 1284 例患者。LN 转移率分别为：无 MI 的分级 1 EC 为 2/414（0.5%）、无 MI 的分级 2 或 3 EC 为 5/239（2.1%）、有 MI 的分级 1 EC 为 5/308（1.6%）、有 MI 的分级 2 或 3 EC 为 14/323（4.3%）。肿瘤大小与 LN 转移概率无关。
适合行保守治疗的年轻患者 LN 宏转移率较低，尤其是分期为 IA、无 MI、分级 1 的 EC。这些患者不应行系统性淋巴结切除术。为评估 EC 保守治疗中 LN 微转移率，可开展评估前哨淋巴结绘图的前瞻性研究。
