Kaban Alpaslan, Topuz Samet, Erdem Baki, Sözen Hamdullah, Salihoğlu Yavuz
Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Mar 21;53(3):252-255. doi: 10.14744/SEMB.2019.55770. eCollection 2019.
This study aims to investigate the rates of extra-uterine metastases of non-endometrioid endometrial tumors limited to the half of the myometrium.
Patients operated for endometrial cancer between 2005-2015 in two gynecologic oncology centers were screened from clinical archives. The inclusion criteria were serous, clear cell, undifferentiated or carcinosarcoma histologies and less than half myometrial invasion. Each histological type was analyzed for adnexal metastasis, lymph node metastasis (pelvic/paraaortic) and omental metastasis.
A total of 116 patients with the median age of 64 (34-72) were examined. Of the patients, 57 were serous (49.1%), 29 were clear cell (25.0%), 27 were carcinosarcoma (23.3%) and 3 (2.6%) were undifferentiated histologic type. Adnexal metastasis (over/tuba) was detected in 15 patients (12.9 %), nodal metastasis in 10 patients (8.6%), and omental metastasis in 15 patients (12.9%). The rates of adnexal metastases were calculated as 14% for serous type, 10% for clear cell type and 11% for carcinosarcoma. Omental metastasis rates were 11% for serous type, 17% for clear cell type and 15% for carcinosarcoma. The rates of extra-peritoneal nodal metastases were calculated as 12% for serous type, 7% for clear cell type and 4% for carcinosarcoma.
According to the findings obtained in this study, the rates of extra-uterine metastasis are high for serous, clear cell or carcinosarcoma types even in the early period. However, the lymph node metastasis in the carcinosarcoma seems to be lower. A comprehensive staging surgery should be planned for these patients, regardless of the depth of myometrial invasion.
本研究旨在调查局限于子宫肌层一半的非子宫内膜样子宫内膜肿瘤的宫外转移率。
从两个妇科肿瘤中心2005年至2015年接受子宫内膜癌手术的患者临床档案中进行筛选。纳入标准为浆液性、透明细胞、未分化或癌肉瘤组织学类型且肌层浸润少于一半。对每种组织学类型分析附件转移、淋巴结转移（盆腔/腹主动脉旁）和网膜转移情况。
共检查了116例患者，中位年龄为64岁（34 - 72岁）。其中，浆液性57例（49.1%），透明细胞29例（25.0%），癌肉瘤27例（23.3%），未分化组织学类型3例（2.6%）。15例患者（12.9%）检测到附件转移（卵巢/输卵管），10例患者（8.6%）有淋巴结转移，15例患者（12.9%）有网膜转移。浆液性类型附件转移率为14%，透明细胞类型为10%，癌肉瘤为11%。网膜转移率浆液性类型为11%，透明细胞类型为17%，癌肉瘤为15%。腹膜外淋巴结转移率浆液性类型为12%，透明细胞类型为7%，癌肉瘤为4%。
根据本研究获得的结果，浆液性、透明细胞或癌肉瘤类型即使在早期宫外转移率也很高。然而，癌肉瘤中的淋巴结转移似乎较低。无论肌层浸润深度如何，都应为这些患者计划全面的分期手术。
