Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer
Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer
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预测子宫内膜样子宫癌患者主动脉旁淋巴结转移的组织病理学预后因素
DOI：
10.1016/j.ygyno.2010.05.004
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发表时间：
2010
期刊：
影响因子：
4.7
通讯作者：
Kurachi H
中科院分区：
文献类型：
--
作者：
Karube Y;Kurachi H
[目的]探讨子宫内膜样癌患者腹主动脉旁淋巴结转移的组织病理学因素。方法自1993年至2004年，在日本东北妇科肿瘤医院对355例子宫内膜样癌患者(I期269例，II期24例，III期62例)进行了盆腔淋巴结(PLN)和腹主动脉旁淋巴结清扫的一期根治术。结果多因素分析显示，pLN转移(p<；0.0001)和卵巢转移(p=0.0080)与PAN转移有关。此外，在PLN转移的部位中，闭孔淋巴结[风险比(RR)16.9，95%可信区间(CI)：4.3~66.4，P<0.0001]和髂总淋巴结(RR：7.1，95%CI：1.1~44.5，P=0.0375)与PAN转移有关。闭孔LN和/或髂总LN和/或卵巢转移(A)联合诊断的敏感性为75.9%(22/29)，阴性预测值为97.8%(304/311)。而闭孔淋巴结转移和/或髂总淋巴结转移和/或3级和/或深肌层侵犯(B)的诊断敏感性分别为100.0%(29/29)和100.0%(198/198)。55.8%(198/355)的患者可以避免联合B组的掌侧剥离。结论本研究结果提示，术前、术中评估联合B组均阳性时，有必要行掌侧剥离。进一步的前瞻性随机对照研究需要在更大的患者群体中进行，以建立利用术前/术中评估来检测PAN转移的策略。
INTRODUCTIONThe purpose of this study was to determine histopathological factors for para-aortic lymph node (PALN) metastasis in patients with endometrioid uterine cancer.METHODSA total of 355 patients (Stage I, n=269; II, n=24; and III, n=62) (FIGO 2009) underwent primary radical surgery including complete systematic pelvic lymph node (PLN) and PALN dissection in Tohoku Gynecologic Cancer Unit (TGCU) between 1993 and 2004. Logistic regression analysis was used to determine the independent prognostic factors for PALN metastasis.RESULTSMultivariate analysis revealed that PLN metastasis (p<0.0001) and ovarian metastasis (p=0.0080) related with PALN metastasis. Moreover, among the sites of PLN metastases, obturator lymph node (LN) [risk ratio (RR): 16.9, 95% confidence interval (CI): 4.3–66.4, p<0.0001] and common iliac LN (RR: 7.1, 95% CI: 1.1–44.5, p=0.0375) related with PALN metastases. In detection of PALN metastasis, combination of obturator LN and/or common iliac LN and/or ovarian metastasis (A) revealed 75.9% sensitivity (22/29) and 97.8% negative predictive value (NPV) (304/311). However, by combination of obturator LN metastasis and/or common iliac LN metastasis and/or grade 3 and/or deep myometrial invasion (B), the detection of PALN metastasis was 100.0% sensitivity (29/29) and 100.0% NPV (198/198). Also, 55.8% (198/355) of patients could have avoided PALN dissection by combination B.CONCLUSIONSThese results suggest that PALN dissection is necessary when combination B is positive by pre- and intra-operative assessments. Further prospective randomized controlled studies need to be conducted in a larger patient population to establish the strategy for detecting PALN metastasis utilizing pre-/intra-operative assessments.