早期子宫内膜癌盆腔淋巴结切除的意义探讨

Clinical significance of pelvic lymphadenectomy in early-stage endometrial cancer

目的探讨早期子宫内膜癌患者盆腔淋巴结转移率、相关因素及预后。方法对2006年1月至2011年3月北京协和医院初治、经全面手术病理分期、病变局限于子宫体的263例早期子宫内膜癌患者的临床资料进行回顾性分析。结果 263例患者中,21例发生盆腔淋巴结转移,转移率为7.98%。单因素分析显示,肿瘤中低分化、肌层浸润深度≥1/2、非子宫内膜样癌、血管淋巴间隙受累(LVSI)、血清CA125≥35U/L是早期子宫内膜癌盆腔淋巴结转移的危险因素。多因素分析显示,仅深肌层浸润和肿瘤中、低分化是早期子宫内膜癌盆腔淋巴结转移的独立危险因素。淋巴结转移组和非转移组的3年无瘤生存率分别为66.7%(14/21)及99.2%(240/242),两组比较,差异有统计学意义(P=0.000)。结论早期子宫内膜癌合并盆腔淋巴结转移的概率低,深肌层浸润及肿瘤中、低分化是盆腔淋巴结转移的独立影响因素。

Objective To study the incidence of pelvic lymph node metastasis,risk factors and prognosis in early-stage endometrial carcinoma.Methods 263 patients with early-stage endometrial carcinoma who underwent hysterectomy plus bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy between January2006 and March 2011 in Peking Union Medical College Hospital recruited in this study,data was analyzed retrospectively.Results The incidence of pelvic lymph node（PLN）metastasis was 7.98%.The positive PLN rate was higher in patients with grade 2/3,deep myometrial invasion,non-endometrioid endometrial carcinoma,lymphovascular space involvement（LVSI）and CA125≥35 U/L.The multivariate analysis revealed that deep myometrial invasion and grade 2/3were independent risk factors for lymph node metastasis.The 3-year disease-free survival rate of patients with PLN metastasis and no PLN metastasis were 66.7% and 99.2%,respectively（P=0.000）.Conclusions The incidence of PLN metastasis in early-stage endometrial carcinoma is low.Deep myometrial invasion and grade 2/3were independent risk factors for PLN metastasis.