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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2014, Vol. 10 ›› Issue (02) : 165 -169. doi: 10.3877/cma.j.issn.1673-5250.2014.02.009

所属专题： 经典病例； 文献；

论著

子宫内膜癌淋巴结转移的高危因素分析：附358例报告
徐珍1, 彭芝兰2,*,*(), 曾俐琴3, 罗喜平3   
  1. 1. 510010　广州，广东省妇幼保健院妇产科；四川大学华西第二医院妇产科
    2. 四川大学华西第二医院妇产科
    3. 510010　广州，广东省妇幼保健院妇产科
  • 收稿日期:2013-10-04 修回日期:2014-01-06 出版日期:2014-04-01
  • 通信作者: 彭芝兰

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

Zhen Xu1, Zhilan Peng2(), Liqin Zeng3, Xiping Luo3   

  1. 1. Department of Obstetrics and Gynecology, Guangdong Women and Children Hospital, Guangzhou 510010, Guangdong Province, China
  • Received:2013-10-04 Revised:2014-01-06 Published:2014-04-01
  • Corresponding author: Zhilan Peng
  • About author:
    (Corresponding author: Peng Zhilan, Email: )
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引用本文：

徐珍, 彭芝兰, 曾俐琴, 罗喜平. 子宫内膜癌淋巴结转移的高危因素分析：附358例报告[J/OL]. 中华妇幼临床医学杂志(电子版), 2014, 10(02): 165-169.

Zhen Xu, Zhilan Peng, Liqin Zeng, Xiping Luo. Clinicopathologic Features and Risk Factors for Pelvic Lymph Node Metastasis in Uterine Endometrioid Cancer: 358 Cases Report[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(02): 165-169.

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．(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>2 cm)[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响的因素（P< 0.05），进行多因素非条件logistic回归分析结果显示，FIGO分期[OR=3.787，95% CI (2.113~6.786)，P = 0.00]是盆腔淋巴结转移的独立危险因素。

结论

FIGO分期晚、肿瘤体积大（直径> 2 cm)、LVSI呈阳性、宫体深肌层浸润及宫旁浸润是导致EC患者发生盆腔淋巴结转移的高危因素。其中，FIGO分期，是盆腔淋巴结转移的独立危险因素。

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
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 logistic regression analysis identified predictors of pelvic lymph node metastasis. All tested for significance using two-tailed tests at the α =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 stageⅠ (n =313, 87.43%) ; stageⅡ (n=12, 3.35%) ; stageⅢ (n=27, 7.54%) ; stageⅣ (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 endometrioid carcinoma and non endometrioid carcinoma[96.2%(306/ 318) vs．95.0%(38/ 40) , P=0.478]．The 3-year rates of OS among 358 patients was 90.1% (323/ 358) ．The 3-year rates of OS in patients of FIGO stageⅠ-Ⅲwere: StageⅠ, 97.1%; stageⅡ, 91.7%; stageⅢ, 85.2%．During the period of follow-up, mortality rate of 358 patients was 3.07%(25/ 358) ．On univariate logistic regression analysis, FIGO stage [OR=4.169, 95%CI(2.693-6.454) , P=0.000], tumor size[OR=7.175, 95%CI(2.590-19.876) , P=0.000], lymph vascular space invasion(LVSI)[OR=6.277, 95 %CI(2.410-16.348) , P=0.000], depth of myometrial invasion[OR = 3.598, 95%CI(1.651-7.841) , P=0.001] and parametrial invasion[OR=9.382 ,95%CI(3.349-26.284) , P=0.000] were significantly associated with pelvic lymph node metastasis．On multivariate non conditional logistic regression analysis, FIGO stage [OR =3.787, 95%CI (2.113-6.786 ) , P=0.000] was highly associated with pelvic lymph node metastasis.

Conclusions

FIGO clinical stage, tumor size (diameter> 2 cm) , LVSI, depth of myometrial invasion, parametrial invasion were related to pelvic lymph node metastasis, and surgical-pathological stages were significantly associated with pelvic lymph node metastasis.

Key words: Endometrial neoplasms, Overall survival rate, Lymph node, Pelvic lymph node metastasis, Risk factor
表1 对导致本组21例患者盆腔淋巴结转移的影响因素进行单因素logistic回归分析
Table 1 Univariate logistic regression analysis on the risk factors for pelvic lymph node metastasis in uterine endometrioid cancer
变量 P OR 95% CI
下限 上限
年龄：≤45岁/>45岁 0.338 1.725 0.566 5.257
肿瘤体积：≤2 cm/>2 cm 0.000 7.175 2.590 19.876
病理学类型：子宫内膜样癌/非子宫内膜样癌 0.646 1.347 0.379 4.792
组织分化程度：高/中/低 0.237 0.778 0.513 1.180
宫体肌层浸润深度：无/<1/2/≥1/2 0.001 3.598 1.651 7.841
脉管癌栓：有/无 0.000 6.277 2.410 16.348
宫旁浸润：有/无 0.000 9.382 3.349 26.284
FIGO分期：Ⅰ/Ⅱ/Ⅲ ～Ⅳ 0.000 4.169 2.693 6.454
表2 对单因素logistic回归分析结果中有统计学意义的影响因素进行多因素非条件logistic回归分析结果
Table 2 Multivariate non-conditional logistic regression analysis on the risk factors for pelvic lymph node metastasis in uterine endometrioid cancer
变量名称 P OR 95% CI
下限 上限
FIGO分期：Ⅰ/Ⅱ/Ⅲ~Ⅳ 0.000 3.787 2.113 6.786
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