Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer.
Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer.
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DOI：
10.1016/j.ygyno.2016.01.002
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发表时间：
2016-03
影响因子：
4.7
通讯作者：
Wright JD
中科院分区：
文献类型：
--
作者：
Jorge S;Hou JY;Tergas AI;Burke WM;Huang Y;Hu JC;Ananth CV;Neugut AI;Hershman DL;Wright JD
虽然淋巴管间隙侵犯（LVSI）是子宫内膜癌淋巴结转移的一个危险因素，但其危险程度尚不清楚。我们研究了不同肿瘤分级和浸润深度组合下与LVSI相关的淋巴结转移风险，并研究了LVSI对生存率的影响。我们确定了2010年至2012年期间诊断的T1A（肌浸润<50%）和T1B（肌浸润> 50%）子宫内膜类腺癌患者，并记录在国家癌症数据库中。报告了与LVSI相关的淋巴结转移风险，并按分级和分期进行分层。采用Kaplan-Meier分析和考克斯比例风险模型研究LVSI与生存率的关系。我们确定了25，907例患者，包括3928例（15.2%）LVSI患者。LVSI组淋巴结阳性率为21.0%，无LVSI组淋巴结阳性率为2.1%（P <0.0001）。在按分期和分级分层的分析中，LVSI与LN转移风险增加3至10倍以上相关。在控制临床和人口统计学特征的多变量模型中，T1A肿瘤淋巴结疾病伴LVSI的风险比为9.29（95% CI，7.29 - 11.84），T1B肿瘤为4.64（95% CI 3.99 - 5.39）。即使在调整淋巴结转移后，LVSI仍与生存率降低相关（HR = 1.92，95% CI 1.56 - 2.36）。LVSI与明显早期子宫内膜癌患者的淋巴结转移独立相关，即使在调整淋巴结转移后，LVSI也是生存的独立预测因子。
While lymphvascular space invasion (LVSI) is a risk factor for nodal metastasis in endometrial cancer, the magnitude of risk is poorly described. We examined the risk of nodal metastasis associated with LVSI for various combinations of tumor grade and depth of invasion and examined the effect of LVSI on survival. We identified patients with T1A (<50% myoinvasion) and T1B (>50% myoinvasion) endometrioid adenocarcinomas of the endometrium diagnosed between 2010 to 2012 and recorded in the National Cancer Database. The risk of nodal metastasis associated with LVSI stratified by grade and stage is reported. The association of LVSI and survival was examined using Kaplan-Meier analyses and Cox proportional hazards models. We identified 25,907 patients, including 3928 (15.2%) with LVSI. Among patients with LVSI, 21.0% had positive lymph nodes, compared to 2.1% in patients without LVSI (P<0.0001). In analyses stratified by stage and grade, LVSI was associated with increased risks of LN metastasis by a magnitude of 3 to over 10-fold. In a multivariable model controlling for clinical and demographic characteristics, the risk ratio of nodal disease with LVSI was 9.29 (95% CI, 7.29-11.84) for T1A tumors and 4.64 (95% CI 3.99-5.39) for T1B tumors. LVSI was associated with decreased survival even after adjustment for the presence of lymph node metastases (HR=1.92, 95% CI 1.56-2.36). LVSI is independently associated with lymph node metastases in women with apparent early-stage endometrial cancer and an independent predictor of survival even after adjustment for the presence of lymph node metastases.