Guo Jianbin, Qian Haili, Ma Fei, Zhang Ying, Cui Xiujuan, Duan Hua
Department of Gynecological Minimal Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ther Adv Med Oncol. 2020 Jun 13;12:1758835920933036. doi: 10.1177/1758835920933036. eCollection 2020.
The aim of this study was to clarify the features and prognostic significance of isolated para-aortic lymphatic metastasis of endometrial cancer.
A retrospective study of patients with stage IIIC endometrial cancer was performed based on the Surveillance, Epidemiology, and End Results (SEER) database. A total of 2767 patients were divided into three groups according to the lymphatic metastasis patterns: isolated pelvic lymphatic metastasis, isolated para-aortic lymphatic metastasis and dual lymphatic metastasis. The clinic-pathological characteristics and prognosis of patients were compared among the three groups.
The proportion of patients with isolated para-aortic lymphatic metastasis was 13.70%. Patients with isolated pelvic lymphatic metastasis or isolated para-aortic lymphatic metastasis shared similar histological characteristics, except that patients with isolated para-aortic lymphatic metastasis had a lower proportion of tumors over 5 cm in diameter than patients with isolated pelvic lymphatic metastasis (35.1% 45.7%, = 0.001). Compared with patients with dual lymphatic metastasis, isolated para-aortic lymphatic metastasis was more common in patients with endometrioid tumors (78.6% 67.3%, < 0.001), grade 1-2 cancers (53.3% 36.3%, < 0.001) and negative peritoneal cytology (76.2% 61.1%, < 0.001). Dual lymphatic metastasis was an independent predictive factor for the poor outcomes of patients at stage IIIC. However, in stage IIIC endometrioid tumors, patients with isolated pelvic lymphatic metastasis and those with isolated para-aortic lymphatic metastasis shared similar prognosis. Patients at stage IIIC with nonendometrioid tumors and patients at stage IV could not be further divided into subgroups according to lymphatic metastasis patterns in terms of prognosis.
Endometrioid patients with isolated pelvic lymphatic metastasis and isolated para-aortic lymphatic metastasis share similar clinical pathological characteristics and prognoses.
本研究旨在阐明子宫内膜癌孤立性主动脉旁淋巴结转移的特征及预后意义。
基于监测、流行病学和最终结果（SEER）数据库，对IIIC期子宫内膜癌患者进行回顾性研究。根据淋巴结转移模式将2767例患者分为三组：孤立性盆腔淋巴结转移、孤立性主动脉旁淋巴结转移和双淋巴结转移。比较三组患者的临床病理特征及预后。
孤立性主动脉旁淋巴结转移患者的比例为13.70%。孤立性盆腔淋巴结转移或孤立性主动脉旁淋巴结转移患者具有相似的组织学特征，不同之处在于，孤立性主动脉旁淋巴结转移患者直径超过5 cm的肿瘤比例低于孤立性盆腔淋巴结转移患者（35.1%对45.7%，P = 0.001）。与双淋巴结转移患者相比，孤立性主动脉旁淋巴结转移在子宫内膜样肿瘤患者中更常见（78.6%对67.3%，P < 0.001）、1-2级癌症患者中更常见（53.3%对36.3%，P < 0.001）以及腹膜细胞学阴性患者中更常见（76.2%对61.1%，P < 0.001）。双淋巴结转移是IIIC期患者预后不良的独立预测因素。然而，在IIIC期子宫内膜样肿瘤患者中，孤立性盆腔淋巴结转移患者和孤立性主动脉旁淋巴结转移患者的预后相似。IIIC期非子宫内膜样肿瘤患者和IV期患者在预后方面无法根据淋巴结转移模式进一步分为亚组。
孤立性盆腔淋巴结转移和孤立性主动脉旁淋巴结转移的子宫内膜样患者具有相似的临床病理特征和预后。
