晚期子宫内膜癌腹膜后淋巴结转移及预后的危险因素分析  

Study on peritoneal lymph node metastasis and high risk prognostic factors in advanced endometrial cancer

作　　者：赵河清 陈龙毅[3] 裘佳琦 王玉林 郭冰虹 黄永文[1] ZHAO Heqing;CHEN Longyi;QIU Jiaqi;WANG Yulin;GUO Binghong;HUANG Yongwen(State Key Laboratory of Oncology in South China,Guangdong Provincial Clinical Research Center for Cancer,Department of Gynaecology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department ofGynaecology,The Sixth Affiliated Hospital of South China University of Technology,Foshan Nanhai District People'sHospital,Foshan 528200,China;Department of Gynaecology,The First People's Hospital of Kashga,KashgaHaspital Affiliated to Sun Yat-sen University,Kashga 844099,China;Department of Gynaecology,CancerHospital Chinese Academy of Medical Sciences,Shenzhen Center,Shenzhen 518117,China;Department ofGynaecology,The Affiliated Cancer Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]华南恶性肿瘤防治全国重点实验室,广东省癌症临床研究中心,中山大学肿瘤防治中心妇科,广东广州510060 [2]华南理工大学附属第六医院(佛山市南海区人民医院)妇科,广东佛山528200 [3]喀什地区第一人民医院(中山大学附属喀什医院)妇科,新疆喀什844099 [4]中国医学科学院肿瘤医院深圳医院妇科,广东深圳518117 [5]汕头大学医学院附属肿瘤医院妇科,广东汕头515041

出　　处：《老年医学研究》2024年第6期1-8,共8页Geriatrics Research

基　　金：新疆维吾尔自治区科技计划项目(2022D01F15,miR-302a-5p靶向XIAP在子宫内膜癌淋巴结转移中的调控作用研究)。

摘　　要：目的探讨影响晚期子宫内膜癌(EC)腹膜后淋巴结(RLN)转移及预后的相关危险因素。方法选取2008年1月—2020年12月中山大学肿瘤防治中心妇科连续就诊的261例晚期(Ⅲa期~Ⅳb期)EC患者,采用logistic回归分析晚期EC患者盆腔淋巴结(PLN)转移和腹主动脉旁淋巴结(PALN)转移(伴/不伴PLN阳性)差异的相关危险因素。采用Kaplan-Meier法绘制生存曲线。采用Log-Rank、Cox回归对患者预后相关因素进行分析,探讨影响晚期EC预后的相关因素。结果261例Ⅲa期~Ⅳb期EC患者均行全子宫/广泛性子宫双附件切除术+RLN清扫术(包括PLN清扫术±PALN清扫术),共有147例患者发生RLN转移,RLN转移率为56.32%。年龄≥60岁(HR=2.51,P=0.013)、神经元特异性烯醇化酶(NSE)≥16.3 ng/mL(HR=2.20,P=0.039)、低分化/去分化癌(HR=2.21,P=0.010)、肌层侵犯深度≥1/2(HR=2.45,P=0.002)、脉管癌栓(HR=4.03,P=0.001)是RLN转移的独立危险因素。肌层侵犯深度≥1/2(HR=3.22,P=0.014)是影响PLN和PALN转移部位差异的独立影响因素。中位随访时间67.7个月,年龄≥60岁(HR=2.57,P=0.001)、NSE≥16.3 ng/mL(HR=2.02,P=0.006)、雌激素受体(ER)不表达(HR=2.61,P=0.014)、孕激素受体(PR)不表达(HR=2.00,P=0.016)、肌层侵犯深度≥1/2(HR=1.87,P=0.018)、脉管癌栓(HR=2.30,P=0.001)是总生存期下降的独立预测因素。结论年龄≥60岁、NSE≥16.3 ng/mL、脉管癌栓、低/去分化癌、肌层侵犯深度≥1/2将导致RLN转移风险升高,建议对该类患者行系统性RLN清扫。当肌层侵犯深度≥1/2时,PALN转移风险增加,建议清扫PALN时应达到肾静脉下水平。年龄≥60岁、NSE≥16.3 ng/mL、ER或PR不表达、肌层侵犯深度≥1/2、脉管癌栓者总生存变差,建议术后积极治疗。Objective To evaluate the risk factors associated with the prognosis and retroperitoneal lymph node(RLN)metastasis of advanced endometrial cancer(EC).Methods A total of 261 patients with advanced(stageⅢa-Ⅳb)pelvic lymph node(PLN)metastasis and para-abdominal aortic lymph node(PALN)metastasis(with/without PLN positivity)in the Gynecology Department of Sun Yat-sen University Cancer Center from January 2008 to December 2020 were included in the study.Logistic regression analysis was used to identify the related risk factors for the differences in PLN metastasis and PALN metastasis(with/without PLN positivity)in patients with advanced EC.Kaplan-Meier method was used to plot the survival curve.Log-rank and Cox regression were used to analyze the prognostic factors of patients and explore the factors that affect the prognosis of advanced EC.Results A total of 261 patients with stageⅢa-Ⅳb EC underwent total hysterectomy/extensive hysterectomy and RLN dissection(PLN dissection±PALN dissection).A total of 147 patients developed RLN metastasis,with an RLN metastasis rate of 56.32%.Age≥60 years(HR=2.51,P=0.013),neuron specific enolase(NSE)≥16.3 ng/mL(HR=2.20,P=0.039),poorly differentiated/dedifferentiated cancer(HR=2.21,P=0.010),muscle invasion depth≥1/2(HR=2.45,P=0.002),and lymphatic vessel infiltration(LVSI)(HR=4.03,P=0.001)were independent risk factors for RLN metastasis.The depth of muscle invasion≥1/2(HR=3.22,P=0.014)was an independent factor affecting the difference in the location of metastasis between PLN and PALN.The me‐dian follow-up time was 67.7 months,the age was≥60 years(HR=2.57,P=0.001),NSE≥16.3 ng/mL(HR=2.02,P=0.006),ER non expression(HR=2.61,P=0.014),PR non expression(HR=2.00,P=0.016),muscle invasion depth≥1/2(HR=1.87,P=0.018),and LVSI(HR=2.30,P=0.001)were independent predictive factors for decreased overall survival.Conclusions Age≥60 years,NSE≥16.3 ng/mL,LVSI,poorly differentiated/dedifferentiated can‐cer,and muscle invasion depth≥1/2 will increase the risk of RLN metastas

关 键 词：子宫内膜癌 腹膜后淋巴结转移 淋巴结清扫 神经元特异性烯醇化酶 预后 

分 类 号：R737.33[医药卫生—肿瘤]