452例低危子宫内膜癌淋巴结转移及预后分析

Lymph node metastasis and prognosis of 452 cases with low risk endometrial carcinoma

目的探讨低危子宫内膜癌的淋巴结转移情况、相关因素及预后。方法回顾性分析2013年1月至2018年9月在郑州大学第一附属医院行分期手术的452例低危子宫内膜癌患者的临床资料,采用单因素分析淋巴结转移的危险因素。结果 452例低危子宫内膜癌患者盆腔和(或)腹主动脉旁淋巴结转移率2.65%(12/452),复发率0.66%(3/452),死亡率0.44%(2/452)。单因素分析显示,浸润表浅肌层、组织学分级G2、低体质指数与淋巴结转移的关联有统计学意义(P <0.05)。年龄、CA125水平、淋巴脉管间隙浸润、肿瘤大小、腹水细胞学阳性等与淋巴结转移的关联无统计学意义(P>0.05)。269例浅肌层浸润患者G1组与G2组淋巴结转移率[1.00%(1/100)、6.51%(11/169)]比较,差异有统计学意义(P <0.05)。结论病变局限于子宫内膜的低危子宫内膜癌患者,无论肿瘤大小及分级,淋巴结转移率低,复发率低,预后好,可不行腹膜后淋巴结切除术;低体质指数、浅肌层浸润且组织学G2的患者淋巴结转移率较高,建议评估淋巴结转移情况。

Objective To investigate the lymph node metastasis(LNM) related factors and prognosis of low risk endometrial cancer(EC). Methods The clinical datas of 452 patients with low-risk EC who underwent staging surgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to September 2018 were retrospectively analyzed and the risk factors for lymph node metastasis(LNM) were analyzed by univariate analysis. Results The pelvic and/or abdominal para aortic lymph node metastasis rate of the low risk EC was 2.65%(12/452), recurrence rate 0.66%(3/452), mortality rate 0.44%(2/452) in 452 patients with low-risk EC. Univariate analysis showed that superficial muscle invasion, histological grade 2(G2) and low body mass index(BMI) were significantly associated with LNM(P < 0.05). There was no significant correlation between age, CA125 level, lymphatic vascular space infiltration, tumor size, positive ascites cytology and LNM(P > 0.05). The lymph node metastasis rates of group G1 and group G2 were 1.00%(1/100) and 6.51%(11/169), respectively, with significant difference between the two groups(P < 0.05). Conclusion Patients with low-risk endometrial cancer whose lesions are confined to the endometrium, regardless of tumor size and grade, have low lymph node metastasis, low recurrence rate and good prognosis, and retroperitoneal lymphadenectomy is not acceptable. Patients with low BMI, superficial muscle invasion, and histologic G2 have a higher rate of lymph node metastasis, so the evaluation of lymph node metastasis is recommended.