Tutkun Kilinc Elif Ceren, Korkmaz Vakkas, Yalcin Hakan Rasit
Department of Gynecology and Obstetrics, Sanko University, Gaziantep, Turkey.
Department of Gynecologic Oncology, Faculty of Medicine, Etlik City Hospital, University of Health Sciences, Ankara, Turkey.
J Obstet Gynaecol. 2022 Nov;42(8):3725-3730. doi: 10.1080/01443615.2022.2158311. Epub 2023 Mar 16.
The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors ( < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI.Impact Statement Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion. Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis. In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.
本研究旨在调查接受系统分期手术的子宫浆液性癌（USC）患者发生淋巴结转移（LNM）的危险因素。对2008年至2020年期间在我院接受单纯子宫浆液性乳头状癌手术的80例患者进行回顾性分析。研究纳入患者的人口统计学信息和临床组织病理学特征对LNM的影响。研究纳入患者的中位年龄为64.3岁，肿瘤直径为3.8厘米。诊断时，65.8%的病例处于晚期，而34.2%处于早期。42例（52.5%）病例无LNM，6例（7.5%）仅盆腔有LNM，4例（5%）患者仅腹主动脉旁有LNM，24例（30%）患者盆腔和腹主动脉旁均有LNM。多因素分析评估可能影响LNM的因素时，发现淋巴管间隙浸润（LVSI）和细胞学阳性是独立危险因素（<0.05）。此外，LNM阳性患者中孤立性腹主动脉旁淋巴结受累率为5%，这与LVSI 100%相关。影响声明子宫乳头状浆液性癌（UPSC）是子宫内膜癌中一种罕见且侵袭性强的组织学亚型。这些肿瘤的高复发风险和向腹腔转移的倾向并不总是与淋巴结和远处器官转移、肿瘤大小、LVSI阳性及肌层浸润深度有关。大多数UPSC患者诊断时已处于晚期。在本项对80例纯浆液性组织学患者进行回顾性评估的研究中，发现LVSI和腹膜细胞学阳性是淋巴结转移的两个重要预后因素。在本研究中，细胞学和LVSI阳性被确定为LNM的两个预测标志物，并且可以看出细胞学阳性在这些有腹膜播散的肿瘤中仍然保持其重要性。此外，孤立性腹主动脉旁淋巴结受累的患者被证明LVSI阳性，对于LVSI阳性的患者应调查是否存在孤立性腹主动脉旁LNM。
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