Tang X, Tanemura K, Ye W, Ohmi K, Tsunematsu R, Yamada T, Katsumata N, Sonoda T
Division of Gynecology, National Cancer Center, Tokyo, Japan.
Jpn J Clin Oncol. 1998 Nov;28(11):673-8. doi: 10.1093/jjco/28.11.673.
By clarifying the significance of clinicopathological factors for retroperitoneal lymph node metastasis and survival of patients with endometrial cancer, we suggest ideas for optimal treatment of this disease.
A retrospective study was conducted in 310 women with endometrial cancer who underwent surgery with retroperitoneal lymphadenectomy. To evaluate retroperitoneal lymph node metastasis, age-adjusted and multivariable analyses were carried out for six clinicopathological factors including pathological grade, myometrial invasion, cervical invasion, peritoneal cytology, lymphatic permeation and vascular invasion. To evaluate survival, besides the above factors, a positive rate of metastasis of dissected retroperitoneal lymph nodes was included.
In 40 patients (13%) with nodal metastasis, the average positive rate of metastasis of dissected retroperitoneal lymph nodes was 22%. For retroperitoneal lymph node metastasis, the odds ratio of deep myometrial invasion, cervical invasion and severe lymphatic permeation were 5.97, 2.72 and 12.01, respectively. For survival, the hazard ratios of the positive rates of metastasis of dissected retroperitoneal lymph nodes (both 25% and < 25%), positive peritoneal cytology and poor pathological grade were 7.10, 3.24, 3.82 and 3.27, respectively, and 5-year survival rates for them were 0, 50, 72 and 77%, respectively.
For retroperitoneal lymph node metastasis, lymphatic permeation, deep myometrial invasion and cervical invasion were the independent prognostic factors. For survival, retroperitoneal lymph metastasis, poor pathological grades and positive peritoneal cytology were the independent prognostic factors. The positive rate of metastasis of dissected retroperitoneal lymph metastasis plays an important role in predicting survival of endometrial cancer. Lymph node biopsy is insufficient in treatment of this disease.
通过阐明临床病理因素对子宫内膜癌患者腹膜后淋巴结转移及生存的意义，我们为该疾病的最佳治疗提供思路。
对310例行腹膜后淋巴结清扫术的子宫内膜癌女性患者进行回顾性研究。为评估腹膜后淋巴结转移情况，对包括病理分级、肌层浸润、宫颈浸润、腹腔细胞学检查、淋巴管浸润和血管浸润在内的六个临床病理因素进行年龄校正和多变量分析。为评估生存情况，除上述因素外，还纳入了清扫的腹膜后淋巴结转移阳性率。
在40例（13%）有淋巴结转移的患者中，清扫的腹膜后淋巴结转移平均阳性率为22%。对于腹膜后淋巴结转移，肌层深部浸润、宫颈浸润和严重淋巴管浸润的比值比分别为5.97、2.72和12.01。对于生存情况，清扫的腹膜后淋巴结转移阳性率（≥25%和＜25%）、腹腔细胞学检查阳性及病理分级差的风险比分别为7.10、3.24、3.82和3.27，其5年生存率分别为0、50%、72%和77%。
对于腹膜后淋巴结转移，淋巴管浸润、肌层深部浸润和宫颈浸润是独立的预后因素。对于生存情况，腹膜后淋巴结转移、病理分级差和腹腔细胞学检查阳性是独立的预后因素。清扫的腹膜后淋巴结转移阳性率在预测子宫内膜癌生存方面起重要作用。淋巴结活检对该疾病的治疗不足。
