Prediction of lymph node metastasis in stage Ⅰ endometrial cancer by evaluation of risk factors pre-and intra-operation / 中国综合临床

ABSTRACT

Objective To selectively resect the lymph nodes in the endometrial cancer by risk factors evaluation pre-and intra-operation.Methods Three hundred and seventy-four cases who in the Obstetric and Gynecology Hospital Affiliated to Fudan University from Oct.2010 and Dec.2012 were clinically diagnosed as stage Ⅰ pre-and intra-operation,grouped as one (staged Ⅰ A,294 cases) and two (staged Ⅰ B,80 cases),and the situation of lymph nodes metastasis and the related risk factors were analyzed.Results (1) Lymph nodes metastasis were positive in 6 cases in group one (2.0％) and 12 cases in group two(15.0％),and the difference was significant between two groups (x2 =23.054,P =0.000).(2) University analyses showed that pathologic type,grade,myometrial invasion,lymphovascular invasion and cervical gland invastion were the risk factors contributed to the lymphatic metastasis in early staged endometrial cancer (P＜ 0.05).Multivariate analysis showed that myometrial invasion was independent risk factor affecting early metastasis of lymph node in endometrial carcinoma (regression coefficient =2.339,standard error =0.585,OR =10.897,95％ CI 3.273 ～ 32.367,P =0.000).(3)Based on the gynecology oncology group test and risk factors that recent used in different countries and clinical centers,superficial myometrial layer invasion,G2,age＞ 60 years,tumor ≥ 2 cm in diameter as the medium risk factors,and deep myometrial layer invasion,G3,lower portion of the uterus or cervical gland invasion as high risk factors,and patients with two or more medium risk factor (106 cases) and with one or more high risk factors(138 cases) were inclined to develop lymph node metastasis((5.66％ (6/ 106),0(0/130),P =0.04;8.70％ (12/138),2.54％ (6/236),P =0.007).(4) Two hundred and thirteen patients were found with superficial layer invasion by frozen section,and 11 of them were upgraded to Ⅰ B by postoperative pathologic examination.Interestingly,all of the 11 cases were accompanied by two medium or one of high risk factor.Conclusion Low incidence of lymph nodes involvement is found in stage Ⅰ endometrial cancer,especial stage Ⅰ A.Myometrial invasion is closely linked to lymph node metastasis,thus,lymphadenectomy should routinely be carried out in endmetrial cancer diagnosed as Ⅰ B whether pre-or intraoperation.As in stage Ⅰ A,unless two medium and one high risk factors are found.