子宫内膜癌淋巴结转移的危险因素及预后分析  

High-risk factors and prognostic analysis of pelvic nodal metastasis in patients with endometrial carcinoma

作　　者：曾靖[1] 李艳[1] 金滢[1] 单莹[1] 王永学[1] 尹婕[1] 韩甜甜[1] 宋晓[1] 潘凌亚[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《基础医学与临床》2017年第4期454-462,共9页Basic and Clinical Medicine

摘　　要：目的探讨子宫内膜癌腹膜后淋巴结转移的高危因素及淋巴结转移对于预后的影响。方法回顾性分析2005年1月至2010年12月期间在北京协和医院妇产科进行诊治的289例行腹膜后淋巴结切除的子宫内膜癌患者的临床病理资料,对影响子宫内膜癌腹膜后淋巴结转移的高危因素和影响子宫内膜癌患者预后的因素进行统计分析。结果 1)289例患者中位发病年龄55岁,Ⅰ期224例(77.5%),Ⅱ期13例(4.5%),Ⅲ期45例(15.6%),Ⅳ期7例(2.4%)。289例行盆腔淋巴结切除,30例(10.4%)有盆腔淋巴结转移;96例行腹主动脉旁淋巴结切除,11例(11.5%)有腹主动脉旁淋巴结转移。复发21例(7.3%),死亡11例(3.8%),中位随访时间37个月,中位无瘤生存时间34个月。2)单因素分析显示术前CA125≥35 U/m L、非子宫内膜样癌、组织学分级为G3、深肌层浸润、肿瘤≥2 cm、宫颈间质受累、腹腔冲洗液细胞学阳性及阴道或宫旁受累是淋巴结转移率的高危因素(P<0.05)。多因素分析显示术前CA125值≥35 U/m L、低分化、肌层浸润深度≥1/2是淋巴结转移的独立危险因素(P<0.05)。3)Kaplan-Meier单因素分析显示,腹腔冲洗液细胞学阳性、阴道或宫旁受累、附件受累及淋巴结转移缩短无瘤生存时间(P<0.05);非子宫内膜样癌、低分化、肌层浸润深度≥1/2、腹腔冲洗液细胞学阳性、附件受累及淋巴结转移缩短总生存时间(P<0.05)。COX回归多因素分析显示,腹膜后淋巴结转移是5年无瘤生存率的独立预后因素(未转移者92.1%vs转移者65.3%,P=0.002,95%CI 0.078~0.552);虽不是5年总生存率的独立预后因素,但无淋巴结转移者的5年总生存率有高于淋巴结转移者的趋势(未转移者96.1%vs转移者70.0%,P=0.086,95%CI 0.039~1.238)。结论本研究发现:1)肿瘤分化程度和肌层浸润深度对淋巴结转移有预测意义,能够指导子宫内膜癌患者是否进行淋巴结切除术,为个体化治疗奠定理论基础。2)淋巴�Objective To investigate the high-risk factors of retroperitoneal lymph nodes metastasis（ LNM） and the effect of lymph nodes metastasis on prognosis in patients with endometrial carcinoma（ EC）. Methods Retrospec-tive research was carried out from January 2005 to December 2010 to identify 289 endometrial carcinoma patients treated with retroperitoneal lymphadenectomy at Peking Union Medical College Hospital. The high-risk factors of retroperitoneal LNM and prognostic factors of this disease were studied. Results 1） The median age at diagnosis was 55 years old. Patients of stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 224（ 77. 5%）,13（ 4. 5%）,45（ 15. 6%） and 7（ 2. 4%）,respectively. Two hundred and eighty-nine patients received pelvic lymphadenectomy,of that 30（ 10. 4%） patients were found the pelvic LNM. Ninety-six patients received periaortic lymphadenectomy,of that 11（ 11. 5%） patients were found the periaortic LNM. Twenty-one（ 7. 3%） patients developed recurrent disease and11（ 3. 8 %） dead. The median follow-up was 37 months and the median disease-free survival（ DFS） was34 months. 2） In univariate analysis,the incidence of LNM significantly increased in patients with CA125 ≥35 U/m L preoperatively,non-endometrioid adenocarcinoma,low grade,deep myometrium invasion,diameter of tumor ≥ 2 cm,cervical stroma involvement,positive peritoneal cytology and vagina or parametrial involvement（ P〈0. 05）. In multivariate analysis,CA125 ≥ 35 U/m L preoperatively,low grade,deep myometrium invasion were the independent high-risk factors of LNM（ P〈0. 05）. 3） The Kaplan-Meier analysis showed a significant difference between positive peritoneal cytology,vagina or parametrial involvement,appendix involvement,LNM and DFS（ P〈0. 05）. We also found a significant difference in the impact of non-endometrioid adenocarcinoma,low grade,deep myometrium invasion,positive peritoneal cytology,appendix involvement and LNM on overall survival（ OS）（ P〈0. 05）. Cox regression analysi

关 键 词：子宫内膜癌 淋巴结 影响因素 预后 

分 类 号：R737.33[医药卫生—肿瘤]