子宫内膜癌淋巴结转移的危险因素分析

Analysis of risk factors for lymph node metastasis of endometrial carcinoma

目的通过研究子宫内膜癌患者淋巴结转移与临床病理因素的相关性,探讨淋巴结转移的危险因素,为手术方案提供参考依据。方法选取2017年9月至2022年9月山西医科大学第二医院分期手术治疗的165例子宫内膜癌患者作为研究对象,以淋巴结转移结果分为阳性组(22例)和阴性组(143例),比较两组临床资料差异,采用二元Logistic回归进行多因素分析。结果(1)纳入本研究的165例子宫内膜癌患者均行全子宫切除术+双附件切除术+盆腔淋巴结清扫术+腹主动脉旁淋巴结切除术,患者术后病理提示淋巴结转移阴性143例(86.67%),淋巴结转移阳性22例(13.33%)。仅盆腔淋巴结转移阳性、仅腹主动脉旁淋巴结转移阳性和盆腔淋巴结合并腹主动脉旁淋巴结转移阳性的发生率分别为6.06%、2.42%和4.85%。(2)两组淋巴结转移的差异性分析显示:BMI、低分化、特殊类型子宫内膜癌、肌层浸润深度≥1/2、宫颈间质受累、侵犯浆膜层、附件转移、宫旁或阴道受累、淋巴脉管间隙浸润(lympho vascular space invasion,LVSI)、微囊型、细长型和碎片型浸润模式(microcysitic elongated and fragmented,MELF)及FIGO分期与淋巴结转移有关(P<0.05)。多因素回归分析显示:侵犯浆膜层、LVSL、FIGO分期(III+IV期)是淋巴结转移的独立危险因素。结论侵犯浆膜层、淋巴脉管间隙浸润、FIGO分期(III+IV期)是淋巴结转移的独立危险因素。

Objective To study the correlation between lymph node metastasis and clinicopathological factors in patients with endometrial cancer,and to explore the risk factors of lymph node metastasis,so as to provide reference for operation.Methods A total of 165 patients with endometrial cancer diagnosed by pathology and treated by staged surgery in the Second Hospital of Shanxi Medical University from September 2017 to September 2022 were selected as the study objects.According to whether lymph node metastasis occurred,they were divided into positive group(22 cases)and negative group(143 cases).The difference of clinical data between the two groups was compared,and multivariate analysis was performed by binary Logistic regression.Results(1)Among the 165 patients with endometrial cancer included in this study,all underwent total hysterectomy,double adnexectomy,pelvic lymph node dissection and para-aortic lymph node dissection.Postoperative pathology showed negative lymph node metastasis in 143 patients(86.67%)and positive lymph node metastasis in 22 patients(13.33%).The incidence of positive pelvic lymph node metastasis only,positive para-aortic lymph node metastasis only and positive pelvic lymph node with para-aortic lymph node metastasis were 6.06%,2.42%and 4.85%,respectively.(2)According to the difference analysis of lymph node metastasis between the two groups,BMI,poorly differentiated,specific types of endometrial carcinoma,depth of myometrium invasion≥1/2,cervical interstitial involvement,invasion of the serosal layer,adnexal metastasis,parauterine or vaginal involvement,lymph vascular space invasion,MELF infiltration pattern and FIGO stage were associated with lymph node metastasis(P<0.05).Multifactor regression analysis showed that invasion of serosal layer,lymph vascular space invasion and FIGO stage(Stage III+IV)were independent risk factors for lymph node metastasis.Conclusion Invasion of serosal layer,lymph vascular space invasion and FIGO stage(Stage III+IV)are independent risk factors for lymph node metastasis.