Tokalioglu Abdurrahman Alp, Oktar Okan, Unsal Mehmet, Aytekin Okan, Yesil Baran, Altas Huseyin, Buran Ayse, Ucar Yesim, Yuksel Dilek, Comert Gunsu Kimyon, Ersak Burak, Kilic Fatih, Kilic Cigdem, Cakır Caner, Koc Sevgi, Tekin Ozlem Moraloglu, Ustun Yaprak, Turan Taner
Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Department of Gynecologic Oncology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
World J Surg Oncol. 2024 Dec 20;22(1):344. doi: 10.1186/s12957-024-03628-7.
The primary objective of this study was to identify the risk of metastasis to lymph nodes above the inferior mesenteric artery (IMA) in endometrioid-type endometrial cancer (EC) and the factors that influence metastasis.
The study included patients who had been operated on for endometrioid-type EC in three gynecological oncology centers between 2007 and 2023. The supramesenteric lymph node (SM-LN) is the region between the left renal vein and the IMA, whereas the inframesenteric lymph node (IM-LN) is the region between the IMA and the aortic bifurcation, as determined by the level of the IMA.
The study sample comprised 412 patients. The median number of lymph nodes excised per patient was 58. The median count was 37 for pelvic lymph nodes, 21 for para-aortic lymph nodes, 8 for IM-LN, and 13 for SM-LN. In the univariate analysis, the factors that were found to be statistically significant in determining SM-LN metastasis included tumor size, depth of myometrial invasion, uterine serosal invasion, lymphovascular space invasion (LVSI), cervical invasion, peritoneal cytology, adnexal metastasis, omental metastasis, non-nodal extrauterine metastasis, pelvic lymph node metastasis, and IM-LN metastasis. In the multivariate analysis, SM-LN metastasis was independently associated with tumor size, LVSI, pelvic lymph node metastasis, and IM-LN metastasis.
In conclusion, in cases of intermediate-high risk EC, it is important to know that the disease spreads to SM-LN in 7.3% of patients. The efficacy of postoperative adjuvant treatment may be inadequate due to a lack of information regarding the SM-LN region.
本研究的主要目的是确定子宫内膜样型子宫内膜癌（EC）转移至肠系膜下动脉（IMA）上方淋巴结的风险以及影响转移的因素。
该研究纳入了2007年至2023年间在三个妇科肿瘤中心接受子宫内膜样型EC手术的患者。肠系膜上淋巴结（SM-LN）是左肾静脉与IMA之间的区域，而肠系膜下淋巴结（IM-LN）是IMA与主动脉分叉之间的区域，由IMA的水平确定。
研究样本包括412例患者。每位患者切除的淋巴结中位数为58个。盆腔淋巴结中位数为37个，腹主动脉旁淋巴结为21个，IM-LN为8个，SM-LN为13个。在单因素分析中，发现决定SM-LN转移具有统计学意义的因素包括肿瘤大小、肌层浸润深度、子宫浆膜侵犯、淋巴管间隙侵犯（LVSI）、宫颈侵犯、腹腔细胞学检查、附件转移、网膜转移、非淋巴结性子宫外转移、盆腔淋巴结转移和IM-LN转移。在多因素分析中，SM-LN转移与肿瘤大小、LVSI、盆腔淋巴结转移和IM-LN转移独立相关。
总之，对于中高危EC病例，重要的是要知道7.3%的患者疾病会扩散至SM-LN。由于缺乏关于SM-LN区域的信息，术后辅助治疗的疗效可能不足。
