Yokoyama Y, Maruyama H, Sato S, Saito Y
Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Zaifu-cho, Japan.
Gynecol Oncol. 1997 Mar;64(3):411-7. doi: 10.1006/gyno.1996.4573.
The purposes of this study were to analyze the relationship between retroperitoneal lymph node (RLN) metastasis and clinical and pathologic risk factors in endometrial cancers, and to clarify the correlation between RLN metastasis and survival of patients with the disease. This analysis included 63 patients with endometrial cancer who underwent simultaneous pelvic lymph node (PLN) and paraaortic lymph node (PAN) dissection between April 1988 and December 1995. Patients with stage Ia grade 1 and stage IV disease were excluded from this analysis. Both PLN and PAN metastases were found in 10.0% (4/40) of patients with stage I (FIGO, 1988) disease. Of 14 cases with PLN metastases, 8 (57.1%) had PAN metastases simultaneously, whereas 4 (8.2%) of 49 cases without PLN metastases had PAN metastases. There was no significant relationship between the sites or numbers of positive PLN and PAN metastases. Multivariate analysis revealed that poor grade and deep myometrial invasion had an independent relationship with PAN metastases, whereas vascular space invasion and cervical invasion were independently associated with PLN metastases. When divided into the groups of stage I-II and stage III, the prognosis of patients with RLN metastases was significantly poorer than that of patients without RLN metastases in each stage. Furthermore, survival of patients with PAN metastases was significantly worse compared with that of patients with only PLN metastases (44.4 and 80.0%, respectively, P < 0.05). These results reveal that PLN and PAN metastases occur frequently even in early-stage endometrial cancer, and that RLN metastases, especially PAN metastases, have a serious impact on patient survival. In conclusion, systemically simultaneous pelvic and paraaortic lymphadenectomy is essential for all the patients with endometrial cancer except those with stage Ia grade 1 and stage IV to provide prognostic information and select suitable postoperative treatment as well as to perform accurate FIGO staging, provided the condition of the patient permits.
本研究的目的是分析子宫内膜癌患者腹膜后淋巴结（RLN）转移与临床及病理危险因素之间的关系，并阐明RLN转移与该疾病患者生存率之间的相关性。该分析纳入了1988年4月至1995年12月期间同时接受盆腔淋巴结（PLN）和腹主动脉旁淋巴结（PAN）清扫术的63例子宫内膜癌患者。Ia期1级和IV期疾病患者被排除在本分析之外。I期（FIGO，1988）疾病患者中，10.0%（4/40）同时存在PLN和PAN转移。在14例有PLN转移的病例中，8例（57.1%）同时有PAN转移，而在49例无PLN转移的病例中，4例（8.2%）有PAN转移。阳性PLN的部位或数量与PAN转移之间无显著关系。多因素分析显示，低分化和肌层深度浸润与PAN转移独立相关，而脉管间隙浸润和宫颈浸润与PLN转移独立相关。当分为I-II期和III期组时，各期有RLN转移患者的预后明显差于无RLN转移的患者。此外，有PAN转移患者的生存率明显低于仅有PLN转移的患者（分别为44.4%和80.0%，P<0.05）。这些结果表明，即使在早期子宫内膜癌中，PLN和PAN转移也很常见，并且RLN转移，尤其是PAN转移，对患者生存有严重影响。总之，对于除Ia期1级和IV期之外的所有子宫内膜癌患者，只要患者情况允许，系统性同时进行盆腔和腹主动脉旁淋巴结清扫术对于提供预后信息、选择合适的术后治疗以及进行准确的FIGO分期至关重要。
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