Hirahatake K, Hareyama H, Sakuragi N, Nishiya M, Makinoda S, Fujimoto S
Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan.
J Surg Oncol. 1997 Jun;65(2):82-7. doi: 10.1002/(sici)1096-9098(199706)65:2<82::aid-jso3>3.0.co;2-j.
Recent studies have shown that poor survival for patients with early endometrial cancer was related to the extrapelvic spread of the cancer. The purpose of this study was to evaluate the correlation between para-aortic lymph node (PAN) metastasis and histopathologic findings and to assess the clinical utility of identifying PAN metastasis of endometrial carcinoma.
The correlation of para-aortic lymph node metastasis to the clinical stages of endometrial carcinoma (FIGO, 1982), histopathologic findings, and prognosis were investigated in 200 patients with endometrial carcinoma, who were treated by radical operations, including systematic retroperitoneal lymphadenectomies, between July 1982 and February 1996.
Of these, para-aortic lymph node (PAN) metastasis was seen in 18 (9.0%) and pelvic lymph node (PLN) metastasis in 40 (20.0%). The incidence of PAN metastasis according to clinical stages Ia, Ib, II, and III were 2.5%, 8.5%, 15.7%, and 33.3%, respectively. The incidence of metastasis was significantly higher in stage II than in stage Ia (P < 0.05), and in stage III than in stage Ia (P < 0.01). PAN metastasis occurred significantly more frequently in the first of each of the following groups: invasion of > 1/2 of the myometrium (15.7%) vs. invasion of < 1/2 of the myometrium (3.6%) (P < 0.01), the group with cervical invasion (23.5%) vs. the group without (4.0%) (P < 0.0001), the group with lymph-vascular space involvement (17.2%) vs. the group without (1.0%) (P < 0.0005), and PLN-metastasis-positive group (40.0%) vs. the negative group (1.3%) (P < 0.0001). Multivariate analysis showed a significant correlation between PAN and PLN metastases (P < 0.0005). Positive PAN metastasis is not related to multiple PLN metastasis (bilateral PLN metastasis and the number of PLN metastatic groups). However, a correlation was seen between PAN metastasis and common iliac node metastasis. The prognosis was significantly poorer (P < 0.05) for patients with both PLN and PAN metastases than for those with PLN metastasis alone.
The results of the present study suggest that PAN metastasis may occur as a consequence of PLN metastasis or the two may occur simultaneously as PLN metastasis and also that careful examination of PAN metastasis is necessary to determine the prognosis.
近期研究表明，早期子宫内膜癌患者生存率低与癌症盆腔外扩散有关。本研究的目的是评估腹主动脉旁淋巴结（PAN）转移与组织病理学结果之间的相关性，并评估识别子宫内膜癌PAN转移的临床效用。
对1982年7月至1996年2月期间接受根治性手术（包括系统性腹膜后淋巴结清扫术）的200例子宫内膜癌患者，研究腹主动脉旁淋巴结转移与子宫内膜癌临床分期（FIGO，1982）、组织病理学结果及预后的相关性。
其中，18例（9.0%）出现腹主动脉旁淋巴结（PAN）转移，40例（20.0%）出现盆腔淋巴结（PLN）转移。根据临床分期Ia、Ib、II和III，PAN转移的发生率分别为2.5%、8.5%、15.7%和33.3%。II期转移发生率显著高于Ia期（P < 0.05），III期高于Ia期（P < 0.01）。在以下每组中的第一组中，PAN转移发生频率显著更高：肌层浸润>1/2者（15.7%）与肌层浸润<1/2者（3.6%）（P < 0.01），有宫颈浸润组（23.5%）与无宫颈浸润组（4.0%）（P < 0.0001），有淋巴管间隙受累组（17.2%）与无淋巴管间隙受累组（1.0%）（P < 0.0005），以及PLN转移阳性组（40.0%）与阴性组（1.3%）（P < 0.0001）。多因素分析显示PAN与PLN转移之间存在显著相关性（P < 0.0005）。PAN转移阳性与多个PLN转移（双侧PLN转移及PLN转移组数量）无关。然而，PAN转移与髂总淋巴结转移之间存在相关性。PLN和PAN均转移的患者预后显著差于仅PLN转移的患者（P < 0.05）。
本研究结果表明，PAN转移可能是PLN转移的结果，或者两者可能作为PLN转移同时发生，并且仔细检查PAN转移对于确定预后是必要的。
