Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e36100. doi: 10.1097/MD.0000000000036100.
To assess the metastatic pattern in pelvic and para-aortic lymph nodes in relation with the primary uterine tumor site and to evaluate risk factors for lymph node metastases. 212 patients with endometrial cancer who underwent surgical treatment from December 2014 to December 2019 were selected. The clinical and pathological data were retrospectively analyzed. The factors and uterine primary tumor site related to lymph node metastasis were analyzed by univariate and multivariate analysis. Among the 212 patients with endometrial cancer, 17 cases had lymph node metastasis, and thus the metastasis rate was 8.02%. Univariate analysis revealed that lymph node metastasis was significantly correlated with Federation of Gynecology and Obstetrics stage, depth of myometrial invasion, tumor size, pathological grade, and lymphovascular space invasion (P < .05) and was not correlated with age, pathological type, and cervical involvement (P > .05). Primary uterine tumor site (fundus, horns, body or lower uterine segment) with or without cervical involvement was associated with different lymph nodes' metastatic sites. The lymph node metastatic pathways of endometrial cancer mainly include obturator lymph nodes and para-aortic lymph nodes, and skip metastasis may occur; endometrial carcinoma may jump and metastasize to para-aortic lymph nodes, specially when the lesion is located in the uterine fundus and uterine horns (cornua of uterus); there is a significant correlation between the location of lymph node metastasis and the location of primary uterine malignant tumor.
评估盆腔和腹主动脉旁淋巴结转移与原发性子宫肿瘤部位的关系，并评估淋巴结转移的危险因素。选择 2014 年 12 月至 2019 年 12 月期间接受手术治疗的 212 例子宫内膜癌患者。回顾性分析其临床病理资料。采用单因素和多因素分析方法分析与淋巴结转移相关的因素和子宫原发性肿瘤部位。在 212 例子宫内膜癌患者中，17 例发生淋巴结转移，转移率为 8.02%。单因素分析显示，淋巴结转移与妇产科联合会分期、肌层浸润深度、肿瘤大小、病理分级和脉管间隙浸润显著相关（P<0.05），与年龄、病理类型和宫颈受累无关（P>0.05）。有或无宫颈受累的原发性子宫肿瘤部位（宫底、宫角、子宫体或子宫下段）与不同的淋巴结转移部位有关。子宫内膜癌的淋巴结转移途径主要包括闭孔淋巴结和腹主动脉旁淋巴结，可能发生跳跃转移；当病变位于宫底和宫角（子宫角）时，子宫内膜癌可能跳跃转移至腹主动脉旁淋巴结，这与宫底和宫角的病变密切相关；淋巴结转移部位与原发性子宫恶性肿瘤的部位存在显著相关性。
