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268例子宫内膜癌淋巴结转移相关因素分析

李艳1,岳天孚2   

  1. 1. 天津市人民医院
    2. 天津医科大学总医院
  • 收稿日期:2011-12-14 修回日期:2012-05-14 出版日期:2012-10-15 发布日期:2012-10-15
  • 通讯作者: 李艳

Analysis of the Related Factors of Lymph Nodes Metastasis in 268 Cases of Endometrial Carcinoma

  • Received:2011-12-14 Revised:2012-05-14 Published:2012-10-15 Online:2012-10-15
  • Contact: Yan LI

摘要: 摘要 目的:探讨子宫内膜癌淋巴结转移的相关因素,为患者提供恰当的手术方案提供依据。方法:收集2002年1月—2011年6月收治的经病理学证实的268例子宫内膜癌患者的临床病理资料并进行回顾性分析。以WHO子宫体肿瘤组织学分类(2003)标准和FIGO最新分期标准为依据进行组织学分型和分期。根据患者淋巴结转移情况分为淋巴结转移阳性组和阴性组,分析两组肌层浸润、病理类型、宫旁受累情况、内膜样癌的分化程度、年龄、腹腔细胞学结果及血清CA125水平的异同,并对上述指标与淋巴结转移之间的关系进行分析。结果:268例子宫内膜癌的淋巴结转移率为10.07%(27/268),主要转移至髂外淋巴结和闭孔淋巴结(占81.48%),腹主动脉旁淋巴结转移率为9.68%(6/62)。淋巴结转移率在深肌层浸润、非内膜样癌、中分化和低分化内膜样癌、累及宫颈或宫旁组织、血清CA125水平升高及年龄≥60岁的患者均分别显著高于无肌层和浅肌层浸润、子宫内膜样癌、高分化内膜样癌、仅限于宫腔内、血清CA125水平正常及年龄<60岁的患者(P均<0.01),而腹腔细胞学阳性与阴性者淋巴结转移率差异无统计学意义。多因素分析结果表明内膜样癌分化程度、肌层浸润和血清CA125水平与淋巴结转移有关(均P <0.05)。结论:深肌层浸润、中低分化子宫内膜样癌和较高的血清CA125水平可作为淋巴结转移的高危因素。

关键词: 子宫内膜肿瘤, 淋巴转移, 淋巴细胞, 肿瘤浸润, CA-125抗原, 危险因素, 病理学, 临床

Abstract: Abstract Objective: To investigate the related clinical-pathological factors of lymph node metastasis in patients with endometrial carcinoma. Methods: A retrospective analysis on 268 patients with endometrial carcinoma from Jan. 2002 to June. 2011 were selected.The patients were classified according to the WHO Classification of Tumors of uterine corpus (2003) and the latest FIGO stage criterion. The patients were divided into lymph node metastasis positive group and negtive. The differences of the following parameters between the two groups were compared: depth of myometrial invasion, pathological type, para-uterus invasion, differential degree of endometrioid carcinoma, age, the result of abdominal cytology and serum CA125 level. Simultaneously, the correlation between the above parameters and lymph node metastasis were analyzed. Result: The lymph node metastasis rate was 10.07%(27/268), and external iliac and obturator lymph nodes were the preferred sites which took up about 81.48%. The abdominal aorta lymph node metastasis rate was 9.68%(6/62). The metastasis rates of patients with deep myometrial invasion, non-endometrioid adenocarcinoma, middle and poorly differentiation, para-uterus invasion, abnormal serum CA125 level, age≥60 were significantly higher than those of patients with non or superficial myometrial invasion, endometrioid adenocarcinoma, well differentiation, without para-uterus invasion, normal serum CA125 level and age<60(P<0.01 for all), respectively. No significantly difference was observed between patients positive and negative for abdominal cytology detection. Differentiation degree of endometrioid adenocarcinoma, myometrial invasion and serum CA125 level are correlated with lymph node metastasis by logistic regression analysis. Conclusion: Deep myometrial invasion, middle & poorly differentiation and elevated serum CA125 level are high risk factors of lymph node metastasis in endometrial cancer patients.

Key words: endometrial neoplasms lymphatic metastasis lymphocytes, tumor-infiltrating CA-125 antigen risk factors pathology, clinical retrospective studies, 临床