子宫内膜癌盆腔淋巴结转移的相关因素分析

Relative factors of lymph node metastasis in endometrial carcinoma

目的:分析子宫内膜癌患者盆腔淋巴结转移的相关因素,探讨这些因素能否用于判断患者淋巴结状态。方法:选取91例1995年1月～2005年1月行根治性子宫切除手术或次根治性子宫切除手术的子宫内膜癌患者,分析患者临床病理特征与腹膜后盆腔淋巴结转移以及淋巴结转移与患者生存期的关系。结果:91例子宫内膜癌患者中,淋巴结转移18例。淋巴结转移在组织分型、分级、肌层浸润、宫颈受累和脉管浸润组间差异有显著性(P<0.05);多因素分析表明:组织类型、肿瘤分级、宫颈受累和脉管浸润为淋巴结转移独立的相关因素。年龄、绝经状态组间差异无显著性(P>0.05)。淋巴结转移患者5年生存率(33.7%)明显低于无淋巴结转移患者(95.8%),有统计学差异。淋巴结转移与患者生存期相关(P<0.05)。结论:非子宫内膜样癌、肿瘤低分化、肌层浸润深、宫颈受累和脉管浸润与淋巴结转移相关,淋巴结转移患者生存期短,预后差。

Objective： To analyze the relationship between lymph node metastases and Clinico-pathological characteristics in endometrial carcinoma and determine whether the factors can predict lymph node metastases. Methods： 91 patients treated with radical and sub-radical hysterectomy were included from Jan. 1995 to Jan. 2005. The relationship between lymph node metastases and Clinico-pathological characteristics and the relationship between lymph node metastases and prognosis were analyzed. Results： Of these patients, 18 had lymph node metastases. The presence of positive lymph nodes correlated with histologic type, depth of invasion, histologic grade, cervical invasion and lymphvascular space invasion （P〈 0.05）. In the multivariate analysis, histologic type, histologic grade, cervical invasion and lymphvascular space invasion were independent prognostic factors for lymph node metastases. Ages and menopausal status were not significantly related to lymph node metastases （P〉0.05）. The 5-year survival rate for patients with lymph node metastases was 53.7%, lower than the 95.8% for patients without lymph node metastases. Lymph node metastases were associated with disease free survivals. Conclusion： Histologic type, grade, cervical invasion and lymphvascular space invasion are associated with lymph node metastases in endometrial carcinoma. The prognosis of patients with lymph node involvement is worse.