Clinicopathological factors predicting retroperitoneal lymph node metastasis and survival in endometrial cancer.
Clinicopathological factors predicting retroperitoneal lymph node metastasis and survival in endometrial cancer.
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DOI：
10.1093/jjco/28.11.673
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发表时间：
1998-11
影响因子：
2.4
通讯作者：
Xi Tang;K. Tanemura;W. Ye;Kazuo Ohml;R. Tsunematsu;Takuro Yamada;Noriyuki Katsumatal;T. Sonoda
中科院分区：
文献类型：
--
作者：
Xi Tang;K. Tanemura;W. Ye;Kazuo Ohml;R. Tsunematsu;Takuro Yamada;Noriyuki Katsumatal;T. Sonoda
背景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和生存的意义，我们提出了子宫内膜癌的最佳治疗思路。方法对310例接受腹膜后淋巴结切除术的子宫内膜癌患者进行回顾性研究。为了评估腹膜后淋巴结转移，我们对病理分级、肌层浸润、宫颈浸润、腹膜细胞学、淋巴浸润和血管浸润等6项临床病理因素进行了年龄调整和多变量分析。为了评估生存率，除上述因素外，还包括腹膜后淋巴结清扫转移阳性率。结果40例（13%）有淋巴结转移的患者中，腹膜后淋巴结清扫的平均转移阳性率为22%。对于腹膜后淋巴结转移，深肌层浸润、宫颈浸润和严重淋巴浸润的比值比分别为5.97、2.72和12.01。生存率方面，腹膜后淋巴结清扫转移阳性率（25%和< 25%）、腹膜细胞学阳性和病理分级差的风险比分别为7.10、3.24、3.82和3.27,5年生存率分别为0、50、72和77%。结论对于腹膜后淋巴结转移，淋巴浸润、深肌层浸润和宫颈浸润是独立的预后因素。对于生存，腹膜后淋巴结转移，病理分级差和腹膜细胞学阳性是独立的预后因素。腹膜后淋巴结转移阳性率对预测子宫内膜癌的生存具有重要意义。淋巴结活检不足以治疗本病。
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.