子宫内膜癌腹膜后淋巴结转移相关因素分析

Analysis of correlation factors with lymph nodes metastasis in endometrial cancer

目的:探讨预测子宫内膜癌腹膜后淋巴结转移的指标,以期为确定子宫内膜癌手术范围提供参考。方法:回顾分析1997年1月至2006年12月初治为手术治疗的641例子宫内膜癌患者的临床与病理资料,单因素分析用χ2检验和Fish确切概率法,多因素分析用Logistic回归模型。结果:经多因素分析显示,病理分级G3、深肌层浸润、附件转移对预测子宫内膜癌盆腔淋巴结(pelvic lymph node,PLN)转移具有统计学意义;盆腔淋巴结转移与腹主动脉旁淋巴结(para-aortic lymph node,PALN)转移显著相关。结论:病理分级G3、深肌层浸润、附件转移是子宫内膜癌盆腔淋巴结转移的重要预测因素;盆腔淋巴结转移对预测腹主动脉旁淋巴结转移具有重要意义。病理分级G3、深肌层浸润、附件转移的子宫内膜癌患者应行盆腔淋巴结清扫术,并根据术中患者的盆腔淋巴结状况决定是否行腹主动脉旁淋巴结清扫术。

Objective：To explore lymph nodes metastasis in endometrial cancer using clinicopathologic variables, and supply reference for deciding surgical extent in endometrial cancer. Methods： From Jan. 1997 to Dec. 2006, a total of 641 patients in endometrial cancer treated with an initial surgical staging procedure were studied retrospectively. Univariate analysis was performed with Chi-square and Fisher＇s exact tests, and multivariate analysis with a logistic regression model. Results： Multivariate analysis revealed that tumor grade 3, depth of myometrial invasion,adnexal metastasis predicted pelvic lymph node（PLN） metastasis significantly. PLN metastasis was closely related with para-aortic lymph node （PALN） metastasis. Conclusion： Tumor grade 3, deep myometrial invasion, adnexal metastasis are independent prognosis factors for PLN metastasis and PLN metastasis is one significant prediction factor for PALN metastasis. To the patient in endometrial cancer with tumor grade 3, deep myometrial invasion, adnexal metastasis, adequate pelvic lymphadenectomy should be performed. When deciding whether to perform para-aortic lymph node dissection,it is necessary to consider the pelvic lymph nodal status.