López-González Elga, Rodríguez-Jiménez Alberto, Rojas-Luna José Antonio, Daza-Manzano Cinta, Gómez-Salgado Juan
Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
Department of Radiology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain.
Cancer Med. 2023 Sep;12(17):17671-17678. doi: 10.1002/cam4.6384. Epub 2023 Aug 21.
To analyze the relationship between tumor volume in Endometrial Cancer (EC) on Magnetic Resonance Imaging (MRI) and lymph node metastasis to establish which patients benefit from omitting the lymphadenectomy.
A retrospective observational study with 194 patients with EC identified between 2016 and 2021 at the Juan Ramón Jiménez University Hospital, Huelva (Spain) was carried out. Preoperative MRI of 127 patients was assessed. The tumor volume was analyzed on MRI by the ellipsoid formula and another alternative method with a manual ROI in different sections. Risk factors for node metastases were analyzed to understand its relationship and to identify an optimum criterion for the tailored surgery.
Univariate analysis showed risk factors for lymph node metastases were histological grade (p = 0.001), tumor with a volume greater than >25 cm (p < 0.001), lymphovascular space invaded (p = 0.007), and preoperative Ca 125 serum >28 (p < 0.001). Multivariate analysis indicated that tumor volume index >25 cm was an independent risk factor for lymph node metastases. The patients without significant proposed risk factors (volume index >25 cm [OR = 0.64], Ca 125 > 28 [OR = 0.32], and high histological grade [OR = 2.6]) did not present lymph node metastases, independent of myometrial invasion.
Lymphadenectomy can be omitted in patients with Endometrioid carcinoma that do not have any of the following risk factors: high-grade tumor, elevated Ca 125 (>28), and tumor volume on MRI greater than 25 cm . Tumor volume might predict the state of lymph nodes in EC and it could give information regarding surgical management.
分析子宫内膜癌（EC）在磁共振成像（MRI）上的肿瘤体积与淋巴结转移之间的关系，以确定哪些患者可从省略淋巴结清扫术中获益。
对2016年至2021年在西班牙韦尔瓦胡安·拉蒙·希门尼斯大学医院确诊的194例EC患者进行回顾性观察研究。对127例患者的术前MRI进行评估。通过椭圆体公式和另一种在不同层面手动绘制感兴趣区（ROI）的替代方法在MRI上分析肿瘤体积。分析淋巴结转移的危险因素，以了解其关系并确定个体化手术的最佳标准。
单因素分析显示，淋巴结转移的危险因素为组织学分级（p = 0.001）、肿瘤体积大于25 cm³（p < 0.001）、淋巴管间隙受侵（p = 0.007）以及术前血清Ca 125>28（p < 0.001）。多因素分析表明，肿瘤体积指数>25 cm³是淋巴结转移的独立危险因素。无显著上述危险因素（体积指数>25 cm³ [OR = 0.64]、Ca 125>28 [OR = 0.32]和高组织学分级[OR = 2.6]）的患者未出现淋巴结转移，与肌层浸润无关。
对于没有以下任何危险因素的子宫内膜样癌患者，可省略淋巴结清扫术：高级别肿瘤、Ca 125升高（>28）以及MRI上肿瘤体积大于25 cm³。肿瘤体积可能预测EC患者的淋巴结状态，并可为手术管理提供信息。
