Ⅰ型子宫内膜癌患者盆腔淋巴结转移危险因素分析  

Analysis of risk factors for pelvic lymph node metastasis in patients with type Ⅰ endometrial cancer

作　　者：李玉杰 孙桂荣[1] 韩晓蓓[1] Li Yujie;Sun Guirong;Han Xiaobei(Department of Clinical Laboratory,Affiliated Hospital of Qingdao University,Qingdao 266003)

机构地区：[1]青岛大学附属医院检验科

出　　处：《现代妇产科进展》2019年第11期808-811,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨Ⅰ型子宫内膜癌(EC)盆腔淋巴结转移的危险因素,为选择性淋巴结切除术提供依据。方法:回顾分析2013年9月至2019年4月于青岛大学附属医院行手术治疗的331例Ⅰ型EC患者的临床病理资料及术前实验室检查结果。结果:20例(6.0%)EC患者发生盆腔淋巴结转移。单因素分析显示,糖类抗原125(CA125)、人附睾蛋白4(HE4)、罗马指数(ROMA)和外周血单核细胞与淋巴细胞比值(MLR)水平升高,肌层浸润≥1/2、宫颈间质浸润、附件受累及腹腔冲洗液细胞学阳性是EC盆腔淋巴结转移的危险因素(P<0.05)。根据ROC曲线,CA125、HE4(绝经前/后)、ROMA指数(绝经前/后)及MLR的cut-off值分别为27.6U/ml,129.1/139.2pmol/L,17.1%/30.1%和0.19。Logistic多因素回归分析表明,CA125>27.6U/ml(OR=11.09,95%CI为2.34~52.49,P=0.002),HE4>129.1(绝经前)/139.2(绝经后)pmol/L(OR=4.26,95%CI为1.43~12.73,P=0.009)以及肌层浸润≥1/2(OR=10.94,95%CI为2.88~41.46,P=0.000)是I型EC盆腔淋巴结转移的独立高危因素。结论:术前CA125、HE4水平及肌层浸润深度可用于评估Ⅰ型EC盆腔淋巴结转移状态,为淋巴结切除术的科学决策提供参考。Objective:To investigate the risk factors of pelvic lymph node metastasis of type I endometrial cancer,and to provide reference for selective lymphadenectomy.Methods:The clinicopathological data and preoperative laboratory results of 331 patients with type I endometrial cancer who underwent surgical treatment in Affiliated Hospital of Qingdao University from Sep.2013 to Apr.2019 were retrospectively analyzed.Results:Pelvic lymph node metastasis occurred in 20(6.0%)patients.Univariate analysis showed that elevated levels of serum carbohydrate antigen 125(CA125),human epididymis protein 4(HE4),ROMA index and peripheral blood monocyte to lymphocyte ratio(MLR),myometrial invasion≥1/2,cervical interstitial infiltration,adnexal involvement and positive peritoneal cytology were risk factors for pelvic lymph node metastasis(P<0.05).According to the ROC curve,the cut-off values of CA125,HE4(before/after menopause),ROMA index(before/after menopause)and MLR were 27.6U/ml,129.1/139.2 pmol/L,17.1%/30.1%and 0.19,respectively.In logistic multivariate analysis,CA125>27.6U/ml(OR 11.09,95%CI 2.34~52.49,P=0.002),HE4>129.1(premenopausal)/139.2(postmenopausal)pmol/L(OR 4.26,95%CI 1.43~12.73,P=0.009),and myometrial invasion≥1/2(OR 10.94,95%CI 2.88~41.46,P=0.000)were independent high-risk factors for pelvic lymph node metastasis of type I endometrial cancer.Conclusions:Preoperative CA125,HE4 levels and the depth of myometrial invasion can be used to evaluate the status of pelvic lymph node metastasis in type I endometrial cancer,which can provide reference for scientific decision-making of lymphadenectomy.

关 键 词：I型子宫内膜癌 淋巴结转移 糖类抗原125 人附睾蛋白4 单核细胞与淋巴细胞比值 

分 类 号：R737.33[医药卫生—肿瘤]