摘要
目的:研究影响子宫内膜癌患者淋巴结转移的因素,评价术中冰冻病理预测淋巴结转移的作用。方法:回顾分析1996年7月至2008年1月在上海交通大学医学院附属仁济医院和2008年9月至2011年9月在同济大学附属第一妇婴保健院收治的共389例子宫内膜癌患者的临床资料,195例患者实施了盆腔淋巴结切除,其中43例同时行腹主动脉旁淋巴结切除。分析患者淋巴结转移的临床相关因素,评价冰冻病理结果在预测淋巴结转移中的价值。结果:盆腔淋巴结转移率为12.8%(25/195),腹主动脉旁淋巴结转移率为11.6%(5/43)。深肌层浸润(P<0.001)、宫颈累及(P<0.001)、ER阴性(P=0.001)与盆腔淋巴结转移显著相关。肿瘤细胞级别升高、病理类型(Ⅰ型、Ⅱ型)与盆腔淋巴结转移无显著相关性。低风险子宫内膜癌(排除G3和肌层深度≥1/2)患者的盆腔淋巴转移率为4.5%(3/67)。按冰冻结果制定4种预测模型,G1+限于内膜组,淋巴结阳性率为0;G1+<1/2肌层组,盆腔和腹主淋巴结阳性率均为2.4%;G2+<1/2肌层组,盆腔和腹主淋巴结阳性率分别为4.8%、0;未发现G2+限于内膜的病例。淋巴结切除组的生存率高于未切除组(79.5%vs 75.9%),但无统计学差异(P=0.086)。结论:冰冻病理用于预测淋巴结转移的作用有限,建议对除G1限于内膜的子宫内膜样腺癌患者,其余均应实施全面的分期手术。
Objective:To investigate the relationship between lymph node(LN) metastases and clinical characteristics in endometrial cancer and evaluate intraoperative frozen section in predicting LN metastases.Methods:From Jul.1996 to Sep.2011,389 endometrial cancer patients undergoing treatment in Department of Gynecology,Renji Hospital,Shanghai Jiaotong University and Department of Gynecology,Shanghai First Maternity and Infant Hospital,Tongji University were enrolled in this retrospective study.Clinical factors related to LN metastases were analyzed.The role of frozen section assessment in predicting LN metastases were evaluated.Results:Pelvic lymph node resection was performed in 195 patients,among which 43 underwent pelvic and para-aortic LN resection.25(12.8%)presented pelvic lymph node(PLN) metastasis and 5(11.6%) presented para-aortic lymph node(PALN) metastasis.Deep myometrial invasion,cervical involvement,negative estrogen receptor correlated with PLN metastasis(P0.001).Higher histologic grade,Ⅱ type endometrial carcinoma were not statistically related to PLN metastasis.According to frozen section analysis combining tumor grade and myometrial invasion,we constructed 4 models to predict lymph node metastasis.G1+no myometrial invasion predictor had no metastasis;G1+1/2 myometrial invasion predictor had a 2.4% risk of both PLN and PALN metastasis.G2+1/2 myometrial invasion predictor had a 4.8% risk of PLN metastasis.There was no statistical difference in overall survival between patients who did and did not undergo lymphadenectomy(P=0.086),however,overall survival in patients with lymphadnectomy showed relatively longer than those in patients without lymphadenectomy(79.5% vs 75.9%).Conclusions:Lymph node metastasis can't be adequately predicted using intraoperative frozen section analysis.It is recommended that comprehensive staging surgery should be performed on endometrial cancer patients,except those who are endometrial adenocarcinoma with G1,no myometrial invasion.
出处
《现代妇产科进展》
CSCD
2013年第1期36-40,共5页
Progress in Obstetrics and Gynecology
关键词
癌
子宫内膜样
淋巴转移
病理学
临床
组织学
冷冻切片
手术期间
Carcinoma
endometrioid
Lymphatic metastasis
Pathology
clinical
Histology
Frozen sections
Intraoperative period