Seon Ki Eun, Shin Yoori, Lee Jung-Yun, Nam Eun Ji, Kim Sunghoon, Kim Young Tae, Kim Sang Wun
Department of Obstetrics and Gynecology, Inha University College of Medicine, Incheon, Korea.
Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
J Gynecol Oncol. 2025 Mar;36(2):e25. doi: 10.3802/jgo.2025.36.e25. Epub 2025 Jan 7.
To evaluate upstaging, lymph node (LN) metastasis, and recurrence in patients with presumed stage I endometrial cancer using preoperative magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT).
Retrospective review of 422 patients with presumed clinical stage I endometrial cancer diagnosed via MRI and PET-CT (July 2014-June 2023). Surgical staging included pelvic lymph nodes (PLNs) and para-aortic lymph nodes (PALNs), classifying patients as low/intermediate- or high-risk groups.
Post-operative upstaging rate was 14.5% (8.8% low/intermediate-risk vs. 22.8% high-risk, p<0.001). LN metastasis occurred in 5.5% of patients (2.0% low/intermediate-risk vs. 10.5% high-risk, p<0.001), with a dual imaging negative predictive value of 0.945. PLN metastasis was 4.5% (2.0% low/intermediate vs. 8.2% high-risk, p=0.003), and PALN metastasis was 2.6% (0.4% low/intermediate-risk vs. 5.8% high-risk, p=0.001). In low/intermediate-risk group: tumors ≤2cm had 1.1% LN metastasis rate, endometrium-limited 0.8%, and ≤2cm with endometrium-limited 0.9%. Deep myometrial invasion (odds ratio [OR]=4.4; 95% confidence intervals [CIs]=1.6-12.4) and tumor size >2 cm on MRI (OR=2.9; 95% CI=0.8-9.9) increased LN metastasis risk. Median 48.5-month follow-up showed an 8.1% overall recurrence rate (4.0% low/intermediate-risk vs. 14.0% high-risk, p<0.001), with 2.4% nodal recurrences (1.2% low/intermediate-risk vs. 4.1% high-risk).
High-risk patients had significant upstaging, LN metastasis, and recurrence rates. Even in low/intermediate-risk groups, some patients exhibited LN metastasis and nodal recurrence, underscoring the importance of comprehensive surgical staging, including PALN evaluation, for precise diagnosis and treatment.
利用术前磁共振成像（MRI）和正电子发射断层扫描-计算机断层扫描（PET-CT）评估疑似I期子宫内膜癌患者的分期上调、淋巴结（LN）转移及复发情况。
回顾性分析2014年7月至2023年6月期间经MRI和PET-CT诊断为疑似临床I期子宫内膜癌的422例患者。手术分期包括盆腔淋巴结（PLN）和腹主动脉旁淋巴结（PALN），将患者分为低/中风险组或高风险组。
术后分期上调率为14.5%（低/中风险组为8.8%，高风险组为22.8%，p<0.001）。5.5%的患者发生LN转移（低/中风险组为2.0%，高风险组为10.5%，p<0.001），双模态成像的阴性预测值为0.945。PLN转移率为4.5%（低/中风险组为2.0%，高风险组为8.2%，p=0.003），PALN转移率为2.6%（低/中风险组为0.4%，高风险组为5.8%，p=0.001）。在低/中风险组中：肿瘤≤2cm的LN转移率为1.1%，局限于子宫内膜的为0.8%，肿瘤≤2cm且局限于子宫内膜的为0.9%。肌层深部浸润（优势比[OR]=4.4；95%置信区间[CI]=1.6-12.4）和MRI上肿瘤大小>2cm（OR=2.9；95%CI=0.8-9.9）增加了LN转移风险。中位随访48.5个月显示总复发率为8.1%（低/中风险组为4.0%，高风险组为14.0%，p<0.001），其中淋巴结复发率为2.4%（低/中风险组为1.2%，高风险组为4.1%）。
高风险患者的分期上调、LN转移及复发率显著。即使在低/中风险组中，部分患者也出现了LN转移和淋巴结复发，这凸显了包括PALN评估在内的全面手术分期对于精确诊断和治疗的重要性。
