Ⅰ期子宫内膜癌盆腔淋巴清扫术的意义

The significance of pelvic lymphadenectomy for stage I endometrial carcinoma.

目的:探讨Ⅰ期子宫内膜癌患者预后的相关因素及盆腔淋巴清扫术对其预后可能的影响。方法:收集1997年8月至2005年3月浙江大学医学院附属妇产科医院临床Ⅰ期子宫内膜癌患者202例,分析影响预后的各项临床病理指标,寿命表法计算生存率,比较盆腔淋巴清扫组与平行淋巴结清扫组的复发率,并发症。结果:Ⅰ期子宫内膜癌盆腔淋巴转移率1·53%。病理类型、腹腔细胞学、盆腔淋巴转移、手术-病理分期、肌层浸润及CA125值是影响预后的独立因素。Ⅰ期低危患者,盆腔淋巴清扫术无助于提高生存率(P>0.05),其复发率也无明显差异(P>0.05),手术并发症率明显增高(P<0.05);Ⅰ期高危患者,盆腔淋巴清扫术未能延长其生存期(P>0·05),但可减少复发的例数,并发症率无明显增多(P>0.05)。结论:特殊病理类型,腹腔细胞学阳性,手术-病理分期高,盆腔淋巴转移,深肌层浸润及CA125>100U/ml的患者预后较差(P<0.05)。Ⅰ期高危子宫内膜癌患者盆腔淋巴清扫术具有一定的临床意义。

Objective：To study the relative factors of the prognosis of clinical stage I endometrial carcinoma and the effect of pelvic lymphadenectomy on prognosis. Methods：Total 202 patients were collected from August 1997 to March 2005. Various clinicopathologic factors that may affect the prognosis were analyzed. The survival rate of various stages was calculated by life table method. Both the recurrence rates and the complication rates were compared between patients with pelvic lymphadenectomy and patients without pelvic lymphadenectomy. Results： For patients with stage I endometrial carcinoma, the metastatic rates of pelvic lymph node were 1.53 %. Pathologic types, peritoneal cytology, pelvic lymph node metastasis, surgical-pathologic stages, myometrlal invasion and CA125 level were independent prognosis factors. For the low risk patients of stage I endometrial carcinoma, pelvic lymphadenectomy did not improve the survival rates （ P 〉 0.05 ） , and did not decrease the recurrence rates （ P 〉 0. 05 ）. Moreover, the complication rates of pelvic lymphadenectomy were higher （ P 〈 0.05 ）. For the high risk patients of stage I endometrial carcinoma, pelvic lymphadenectomy could not improve the survival （P 〉 0. 05） , but it decreased the number of recurrence. Moreover, pelvic lymphadenectomy for the high risk patients did not increase the complication rates （P 〉 0.05 ）. Conclusion ： Uncommon pathologic types （ no endometrioid carcinoma）, positive peritoneal cytology, higher surgicalpathologic stages,positive pelvic lymph node, deep myometrial invasion and CA125 〉 100u/ml were poor prognosis factors for patients with endometrial carcinoma （ P 〈 0. 05 ）. Pelvic lymphadenectomy may have clinical significance for the high risk patients with clinical stage I endometrial carcinoma.