子宫内膜癌淋巴结转移对预后的影响

EFFECT OF NODAL METASTASIS ON THE PROGNOSIS OF PATIENTS WITH ENDOMETRIAL CANCER

为研究子宫内膜癌淋巴结转移对预后的影响 ,回顾性分析 2 30例子宫内膜癌患者临床及病理资料。结果显示腹膜后淋巴结转移者 32 (2 0 2 5 % )例。其中单纯盆腔淋巴结 (PLN)转移者 2 2例 ,盆腔及腹主动脉旁淋巴结均阳性者 4例 ,单纯腹主动脉旁淋巴结(PALN)转移者 6例。腹水细胞学阳性、附件转移和盆腔淋巴结转移的数量增加与主动脉旁淋巴结转移有关 (P <0 0 1)。不管腹主动脉旁淋巴结有无转移 ,首次复发部位以盆腔为主。中位随访 4 0个月 ,腹主动脉旁淋巴结转移者的 3年生存率为 70 % ,单纯盆腔淋巴结转移者生存率为 72 % (P >0 0 5 )。

To study the nodal distribution in endometrial carcinoma and to evaluate its effect on recurrence and survival, 230 patients with endometrial carcinoma were reviewed and analyzed. 32(20 25%)cases were found to have lymph node metastasis. Stage Ⅲc disease was defined by positive PLN alone in 22 cases, positive PLN and PALN in 4 cases, and positive PALN alone in 6 cases. Positive peritoneal cytology and adnexal metastasis were present in 10 patients. Only 2/10 of these patients had isolated positive PLN whereas 8/10 had positive PALN ( P <0 01). At a median follow up for 40 months, the 3 year survival rate was 70% and 72% for patients with positive PALN and isolated PLN disease respectively( P >0 05). These findings indicate that PALN involvement is common in patients with FIGO Stage Ⅲc endometrial cancer, and suggest that PLN sampling alone may result in underdiagnosis of disease, and dissection of PALN may have a significant therapeutic role.