子宫内膜癌初始病灶大小与淋巴结转移及复发的关系  

Correlation between the primary tumor size of endometrial carcinoma and lymph node metastasis and recurrence

作　　者：郭聪敏 戴一博 耿京[1] 李赫 董阳阳[1] 王志启[1] 王建六[1] Guo Congmin;Dai Yibo;Geng Jing;Li He;Dong Yangyang;Wang Zhiqi;Wang Jianliu(Department of Obstetrics and Gynecology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院妇产科,100044

出　　处：《中华妇产科杂志》2021年第4期264-270,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81972426);国家重点研发计划(2019YFC1005200,2019YFC1005201)。

摘　　要：目的探讨子宫内膜癌患者初始病灶大小与淋巴结转移及复发的关系。方法选择2006年1月至2016年12月北京大学人民医院收治的具有完整临床病理资料及随访资料,且有诊刮或宫腔镜检查前宫腔病灶超声检查资料的子宫内膜癌患者共385例,其年龄为(57±10)岁(范围:29~88岁);均于本院接受手术治疗,手术方式包括子宫全切除+双侧附件切除术、子宫内膜癌分期手术、肿瘤细胞减灭术,其中334例行淋巴结切除术;术后复发28例。回顾性分析子宫内膜癌患者的初始病灶大小及其相关影响因素,进一步对不同初始病灶大小(分为0~<2、2~<3、3~<4、4~<5、≥5 cm)及其不同截断值(分别为2、3、4、5 cm)的子宫内膜癌患者淋巴结转移率及复发率进行比较,并通过受试者工作特征(ROC)曲线分析得出预测子宫内膜癌淋巴结转移及复发的最佳截断值。结果(1)385例子宫内膜癌患者的初始病灶大小为(3.6±1.8)cm(范围:1~15 cm);其中,0~<2 cm 48例,2~<3 cm 78例,3~<4 cm 92例,4~<5 cm 73例,≥5 cm 94例。子宫内膜癌患者初始病灶大小与年龄、绝经状态、术前血清CA_(125)水平、有无分娩史、病理分化程度、手术病理分期、肌层浸润深度以及有无子宫颈间质受累、附件转移、淋巴结转移明显相关(P<0.05),而与体质指数、有无高血压史及糖尿病史、病理类型、有无淋巴脉管间隙浸润无关(P>0.05)。(2)334例行淋巴结切除术患者中,淋巴结有转移45例(13.5%,45/334)。对不同初始病灶大小(分为0~<2、2~<3、3~<4、4~<5、≥5 cm)进行的分层分析显示,随着初始病灶的增大子宫内膜癌患者的淋巴结转移率及复发率均显著增高(P<0.05);再分别以2、3、4、5 cm为初始病灶大小的截断值进行分析显示,除截断值为2 cm时不同初始病灶大小(指≥2 cm与<2 cm)患者的淋巴结转移率及复发率分别比较均无显著差异(P>0.05)以外,其他各截断值下不同初始病灶大小患者�Objective To investigate the clinical significance of the primary tumor size in patients with endometrial carcinoma(EC).Methods A total of 385 patients with EC admitted to Peking University People's Hospital from January 2006 to December 2016 with complete follow up data were selected,whose tumor size data before biopsy were retrospectively studied.Results(1)The mean diameter of the primary tumor was(3.6±1.8)cm(range:1-15 cm).And 48 cases were 0-<2 cm,78 cases were 2-<3 cm,92 cases were 3-<4 cm,73 cases were 4-<5 cm,94 cases were≥5 cm.The diameter of the tumor was associated with age<60 years old,premenopause,CA_(125)≥35 kU/L,non-parturition,poor differentiation,stageⅢ-Ⅳ,depth of myometrial infiltration≥1/2,cervical interstitial involvement,adnexal metastasis and lymph node metastasis(all P<0.05),but not associated with body mass index,hypertension,diabetes mellitus,pathology,lymph-vascular space invasion(all P>0.05).(2)Among the 334 patients underwent lymphadenectomy,45(13.5%,45/334)cases with lymph node metastasis were observed.Stratified analysis showed that lymph node metastasis and recurrence rate of patients with EC gradually increased with the increase of tumor size(P<0.05).Adopting 2,3,4 and 5 cm as cut-off values of tumor size,there were significant differences in the rate of lymph node metastasis and recurrence among them observed(P<0.05),except for lymph node metastasis rate and recurrence rate when the cut-off value was 2 cm(P>0.05).(3)An receiver operating characteristic(ROC)curve analysis showed that a tumor diameter of 4.25 cm was the cut-off prognostic value to predict lymph node metastasis and recurrence of EC.Conclusions Tumor diameter is significantly correlated with lymph node metastasis and recurrence in patients with EC.Tumor size should be considered in determining the scope of surgery and adjuvant therapy.

关 键 词：子宫内膜肿瘤 淋巴转移 肿瘤侵润 预后 

分 类 号：R737.33[医药卫生—肿瘤]