The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma.
The pattern of myometrial invasion as a predictor of lymph node metastasis or extrauterine disease in low-grade endometrial carcinoma.
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DOI：
10.1097/pas.0b013e318299f2ab
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发表时间：
2013-11
期刊：
影响因子：
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通讯作者：
Malpica A
中科院分区：
文献类型：
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作者：
Euscher E;Fox P;Bassett R;Al-Ghawi H;Ali-Fehmi R;Barbuto D;Djordjevic B;Frauenhoffer E;Kim I;Hong SR;Montiel D;Moschiano E;Roma A;Silva E;Malpica A
本研究的目的是在多机构环境中检查低级别（FIGO 1级或2级）类胶质瘤（LGEC）淋巴结转移（LN+）或子宫外疾病（艾德）的预测因子。对于LGEC伴或不伴LNM或艾德，9个参与机构中的每一个都评估了患者年龄、肿瘤大小、子宫肌层浸润（MI）、FIGO分级、%实性成分、乳头状结构的存在或不存在、微囊伸长和碎裂腺体（MELF）和单细胞/细胞簇浸润（SCI）、淋巴血管浸润（LVI），子宫下段（LUS）和子宫颈间质（CX）受累以及盆腔（PLN）和腹主动脉旁（PALN）淋巴结的数量。对302例病例进行了回顾性分析：LN+或艾德+，96例; LN-/艾德-，208例。患者年龄范围为23-91岁（中位数61岁）。表1总结了LN+或艾德+组的组织病理学变量：肿瘤大小≥ 2 cm，93/96（97%），MI > 50%，54/96（56%），MELF，67/96（70%），SCI，33/96（34%），LVI，79/96（82%），>20%实性，65/96（68%），存在乳头状结构，68/96例（72%），LUS受累64/96例（67%），CX受累31/96例（32%）。对于LN-/艾德-组，结果如下：肿瘤大小≥2cm，152/208（73%），MI > 50%，56/208（27%），MELF，79/208（38%），单细胞浸润，19/208（9%），LVI，56/208（27%），>20%实性，160/208（77%），122/208例（59%）存在乳头状结构，77/208例（37%）LUS受累，31/208例（15%）CX受累。没有证据表明两组之间盆腔或主动脉旁LN采样数量存在差异（分别为p=0.9和0.1）。多因素分析显示，子宫肌层浸润深度、宫颈间质受累、淋巴血管间隙浸润和单细胞浸润模式是晚期疾病的重要预测因素。虽然单变量分析指出LUS受累、MELF浸润模式和乳头状结构可能是晚期疾病的预测因素，但多变量分析显示这些因素并不显著。本研究验证了MI、CX受累和LV作为LN+或ED的重要预测因子。SCI模式与晚期LGEC的相关性是一个新发现。
The purpose of this study was to examine predictors of lymph node metastases (LN+) or extrauterine disease (ED) in low grade (FIGO grades 1 or 2) endometrioid carcinoma (LGEC) in a multi institutional setting. For LGEC with and without LNM or ED, each of the 9 participating institutions evaluated patients age, tumor size, myometrial invasion (MI), FIGO grade, % solid component, the presence or absence of papillary architecture, microcystic elongated and fragmented glands (MELF) and single cell/cell cluster invasion (SCI), lymphovascular invasion (LVI), lower uterine segment (LUS) and cervical stromal (CX) involvement and numbers of pelvic (PLN) and para-aortic (PALN) LNs sampled.302 cases were reviewed: LN+ or ED +, 96; LN-/ED-, 208. Patients' ages ranged from 23-91 yrs (median 61). Table 1 summarizes the histopathologic variables that were noted for the LN+ or ED+ group: tumor size ≥2cm, 93/96 (97%), MI >50%, 54/96 (56%), MELF, 67/96 (70%), SCI, 33/96 (34%), LVI, 79/96 (82%), >20% solid, 65/96 (68%), papillary architecture present, 68/96 (72%), LUS involved, 64/96 (67%) and CX involved, 31/96 (32%). For the LN-/ED- group, the results were as follows: tumor size ≥2cm, 152/208 (73%), MI >50%, 56/208 (27%), MELF, 79/208 (38%), single cell invasion, 19/208 (9%) , LVI, 56/208 (27%), >20% solid, 160/208 (77%), papillary architecture present, 122/208 (59%), LUS involved, 77/208 (37%), CX involved, 31/208 (15%). There was no evidence of a difference in the number of pelvic or para-aortic LNs sampled between groups (p=0.9 and 0.1, respectively). Following multivariate analysis, depth of myometrial invasion, cervical stromal involvement, lymphovascular space invasion, and the single cell pattern of invasion emerged as significant predictors of advanced stage disease. Although univariate analysis pointed to LUS involvement, MELF pattern of invasion, and papillary architecture as possible predictors of advanced stage disease, these were not shown to be significant by multivariate analysis. This study validates MI, CX involvement and LV as significant predictors of LN+ or ED. The association of SCI pattern with advanced stage LGEC is a novel finding.