Ⅰ期子宫内膜样腺癌盆腔淋巴结转移的危险因素

Risk Factors of Pelvic Lymph Node Metastasis in StageⅠEndometrioid Adenocarcinoma

目的探讨初诊Ⅰ期子宫内膜样腺癌(EA)的盆腔淋巴结转移(PLNM)情况及危险因素。方法回顾性分析2014年1月至2019年9月在郑州大学第一附属医院接受手术治疗的548例初诊Ⅰ期EA患者的临床病历资料。结果LNM发生率为6.0%(33/548)。单因素分析显示,术前低体质量指数(BMI)、血清糖类抗原(CA)125升高、血清CA199升高、低分化(G3)、子宫肌层浸润深度(MI)≥1/2肌层及淋巴血管间隙浸润(LVSI)与临床Ⅰ期EA患者发生PLNM有关(P<0.05),年龄、肿瘤大小、盆腔淋巴结切除数目与PLNM无关(P>0.05)。多因素分析显示,BMI<26.28 kg·m^(-2)(OR=0.258,95%CI:0.096~0.698,P=0.008)、CA199≥19.66 U·mL^(-1)(OR=4.468,95%CI:1.859~10.740,P=0.001)、MI≥1/2肌层(OR=4.824,95%CI:1.997~11.654,P<0.001)、LVSI(OR=6.267,95%CI:2.033~19.319,P<0.001)是Ⅰ期EA患者发生PLNM的独立危险因素。结论BMI<26.28 kg·m^(-2)、CA199≥19.66 U·mL^(-1)、MI≥1/2肌层、LVSI是Ⅰ期EA患者发生PLNM的独立危险因素,联合以上指标评估淋巴结转移风险,有助于指导淋巴结切除术的实施。

Objective To investigate the status and risk factors of pelvic lymph node metastasis(PLNM)in newly diagnosed stageⅠendometrioid adenocarcinoma(EA).Methods The clinical medical records of 548 newly diagnosed patients with stageⅠEA who underwent surgery in the First Affiliated Hospital of Zhengzhou University from January 2014 to September 2019 were retrospectively analyzed.Results The incidence of PLNM was 6.0%(33/548).Univariate analysis showed that preoperative low body mass index(BMI),elevated serum carbohydrate antigen(CA)125 level,elevated serum CA199 level,poor differentiation(G3),myometrial invasion(MI)≥1/2 muscle layer and lymph vascular space invasion(LVSI)were related to the occurrence of PLNM in patients with clinical stageⅠEA(P<0.05),while age,tumor size,and the number of pelvic lymph nodes removed were not related to PLNM(P>0.05).Multivariate analysis showed that BMI<26.28 kg·m^(-2)(OR=0.258,95%CI:0.096-0.698,P=0.008),CA199≥19.66 U·mL^(-1)(OR=4.468,95%CI:1.859-10.740,P=0.001),MI≥1/2 muscular layer(OR=4.824,95%CI:1.997-11.654,P<0.001),LVSI(OR=6.267,95%CI:2.033-19.319,P<0.001)were independent risk factors for PLNM in patients with stageⅠEA.Conclusion BMI<26.28 kg·m^(-2),CA199≥19.66 U·mL^(-1),MI≥1/2 myometrium,and LVSI are independent risk factors for PLNM in patients with stageⅠEA.The combined application of the above indicators to assess the risk of lymph node metastasis will help guide the implementation of lymph node resection.