Assessment Of Lymphatic Node Metastasis In Endometrial Carcinoma And Correlation With Lymphangiogenesis

Objective:(1)To investigate the prognostic value of lymphadenectomy in patients with low risk endometrial cancer(EC).To predict the risk of lymph node metastasis with low risk EC using clinicopathological factors,such as tumor size and immunostaining expressions of estrogen and progesteron receptor.(2)To analyze the relationship between the expressions of lymphatic vessel endothelial hyaluronan receptor-1(LYVE-l)?prospero-related homeobox-1(Prox-1)in cancer tissues and paracancer tissues with endometrial carcinoma and lymph node metastasis.Method:(1)Retrospective review 486 patients who were pathologically diagnosed as endometrioie EC,assigned to undergo lymphadenectomy(n=366)or no lymphadenectomy(n=120).According to the European Society of Medical Oncology(ESMO),patients can be classified as having early-stage EC at low-,intermediate-,or high-risk group.Lymph node metastasis rate and survival analysis was performed.Tumor size?positive expression rate of estrogen receptor and progesteron receptor cut-offs were determined according to final nodal status.The results of preoperative?intraoperative and postoperative diagnoses were compared.The number of lymph node excising?with lymphadenectomy and without lymphadenectomy and the disease recurrence were observed.(2)57 cases of endometrial carcinoma and 30 cases of nomal endometrial tissues were selected.15 paired cancer and paracancer fresh specimens were collected.To examine LYVE-1 and Prox-1 in cancer tissues and paracancer tissues by immunohistochemistry?Western blot and RT-PCR.Correlation of LYVE-1 and Prox-1 expression with clinicopathological factors was analyzed.Results:(1)The lymph node metastasis rate and recurrence rate in low-risk group were significantly lower than that in intermediate-and high-risk group.(2)Using a cut-off of 20 mm,no correlation was found.The positivity cut-offs defined were 47.5mm in intermediate-and high-risk group;55% for ER and 32.5% for PR.(3)There was agreement between the pre-and postoperative grade in 57.3%,depth of myometrial invasion in 80.0% of the lymphadenectomy group Accordin to the paraffin section results,the overall concordance rate of frozen section tumor grade was 57.3%;depth of myometrial invasion was 97.8%.(4)There was no statistically significant difference between three risk gropes of the number of lymph node.(5)The recurrence rate?mortality rate and the 5-year cumulative survival rate were similar between lymphadenectomy and no lymphadenectomy group.(6)The LYVE-1 and Prox-1 positive expression rate in cancer tissues were lower than those in nomal endometrial tissues.The LYVE-1?Prox-1 positive expression rate in paracancer tissues were significantly higher than those in cancer tissues and nomal endometrial tissues.(7)The LYVE-1 positive expression rate in cancer tissues was not associated with clinicopathological factors.There was a significant correlation between the Prox-1 positive expression rate and tumor grade.(8)Significant differences in paracancer tissues with LYVE-1 positive expression rate appear between LVSI positive and LVSI negative.The Prox-1 positive expression rate in paracancer tissues was significant correlation with LVSI and tumor stage.(9)The LYVE-1 and Prox-1 positive expression rate in paracancer tissues with lymph node metastases were significantly higher than those non lymph node metastases.Conclusion:(1)There was low lymph node metastasis rate in low-risk EC and to safely omit lymphadenectomy.Lymph node metastasis was not associated with 2cm.Preoperative,intraoperative assessment of low risk factors is essential.There was a no correlation between the number of lymph node and prognosis.High risk factors or upstage in patients without lymphadenectomy in low risk EC can be supplemented with adjuvant therapy,the prognosis is still optimistic.(2)The generation of lymphatic vessels is related to lymph node metastasis.Prox-1 may be involved in progression in endometrial carcinoma.