子宫内膜癌淋巴结转移的高危因素分析:附358例报告  

Clinicopathologic Features and Risk Factors for Pelvic Lymph Node Metastasis in Uterine Endometrioid Cancer:358 Cases Report

作　　者：徐珍[1,2] 彭芝兰[2] 曾俐琴[1] 罗喜平[1] 

机构地区：[1]广东省妇幼保健院妇产科,广州510010 [2]四川大学华西第二医院妇产科

出　　处：《中华妇幼临床医学杂志（电子版）》2014年第2期37-41,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省科技厅基金资助项目(FG002-001)~~

摘　　要：目的探讨子宫内膜癌(EC)的临床病理学特征及淋巴结转移的预测因素。方法回顾性分析2007年3月至2010年4月四川大学华西第二医院妇科收治,并经术后组织病理学结果确诊为EC的358例患者的完整临床病历资料。其初治为系统分期手术,并进行盆腔及腹主动脉旁各组淋巴结计数。对本组EC患者进行临床病理特点分析,并进行随访,对EC盆腔淋巴结转移的可能相关因素进行统计学分析(本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。结果本组358例EC患者的中位发病年龄为52岁(20～78岁)。对本组患者的中位随访时间为18个月,其中位生存期为18个月(7～43个月),3年总体生存(OS)率为90.1%(323/358)。本组盆腔淋巴结病理学检查结果呈阳性和呈阴性患者的3年OS率分别为76.2%(16/21),97.3%(327/336),二者比较,差异有统计学意义(χ2=23.423,P<0.01)。子宫内膜样癌和非子宫内膜样癌患者的3年OS率分别为:96.2%(306/318)与95.0%(38/40),差异无统计学意义(P=0.478)。国际妇产科联盟(FIGO)分期不同患者的3年OS率分别为:Ⅰ期为97.1%(304/313),而Ⅱ期为91.7%(11/12);Ⅲ期为85.2%(23/27)。本组患者随访期内EC的相关复发率为3.9%(14/358),死亡率为3.1%(11/358),盆腔淋巴结转移率为5.9%(21/357)。对导致21例患者盆腔淋巴结转移的可能相关因素进行单因素logistic回归分析结果显示,FIGO分期[OR=4.169,95%CI(2.693～6.454),P=0.000],肿瘤体积(肿瘤直径>2cm)[OR=7.175,95%CI(2.590～19.876),P=0.000],淋巴脉管间隙浸润(LVSI)[OR=6.277,95%CI(2.410～16.348),P=0.000],宫体肌层浸润深度[OR=3.598,95%CI(1.651～7.841),P=0.001]和宫旁浸润[OR=9.382,95%CI(3.349～26.284),P=0.000]是导致EC患者盆腔淋巴结转移的高危因素;对以上单因素logical回归分析结果显示,对盆腔淋巴转移有影�Objective To study risk factors for pelvic lymph node metastasis in uterine endometrioid cancer（EC）.Methods Single institution retrospective study of 358 patients with Federation International of Gynecology and Obstetrics （FIGO ） stage Ⅰ-Ⅳ EC. All patients were treated with primary surgery consisting of total abdominal （n = 326 ） or laparoscopic （n = 32 ） hysterectomy, bilateral salpingooophorectomy,pelvic and （or）paraaortic lymphadenectomy and peritoneal cytology.Follow-up methods were outpatient visit and telephone interview.Univariate and multivariate analyses to predict distant recurrence or survival from disease were performed comparing known risk factors.Multivariable＆amp;nbsp;logistic regression analysis identified predictors of pelvic lymph node metastasis.All tested for significance using two-tailed tests at theα= 0.05 level.Significance was set at the P〈0.05 level in all analyses. Statistical analysis was carried out by means of the statistical package for the social sciences （SPSS）software version 18.0.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University.Informed consent was obtained from all participants.Results The surgical-pathological stages among 358 patients were stage Ⅰ （n=313, 87.43%）;stage Ⅱ（n=12,3.35%）;stage Ⅲ（n=27,7.54%）;stage Ⅳ（n=6,1.68%）.The histological types include endometrioid （n=318,88.83%）,and no-endometrioid adenocarcinoma（n=40,11.17%）. The median age of 358 patients was 52 years old （20-78 years old）.The median follow-up of 358 patients was 18 months,and their median overall survival （OS）time was 18 months （7-43 months）.There had significant difference in rates of 3-year OS between patients with positive and negative of pathological results of pelvic lymph node [76.2%（16/21）vs.97.3%（327/336）;χ2 =23.423,P〈0.01].There had no significant difference in rates of 3-year OS between patients with endometri

关 键 词：子宫内膜肿瘤 总体生存率 淋巴结 盆腔淋巴结转移 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]