Analysis Of Risk Factors Affecting Lymph Node Metastasis In Endometrial Carcinoma

Objective : The aim of this study was to estimate the risk factors of lymph node metastasis in endometrial carcinoma in order to select appropriate surgical procedure.Methods : The clinical-pathologic factors of 131 patients with endometrial carcinoma who underwent thoroughly surgical-pathologic staging procedure from January 2001 to January 2007 at Qilu Hospital of Shandong University were retrospectively studied. The average age of 131 patients was 53.6±8.6 years (range 25-74years) and the median age was 54years. Endometrioid adenocarcinoma had 116 cases, and other 15 cases were diagnosed as special pathologic subtype , including 8 cases as serous papillary adenocarcinoma, 4 cases as clean cell adenocarcinoma, 1 cases as squamous cell carcinoma , 2 cases as undifferentiated carcinoma. All 131 patients underwent pelvic lymphadenectomy and abdominal paraaortic lymph node sampling.Results : (1)Of 131 patients, 18 patients had lymph node metastasis and the metastatic rate was 13.7%. In endometrioid carcinoma, lymph node metastasis occurred in 8.6%(10/116) ,while in patients with special pathologic type, the rate was 53.3%(8/15). Paraaortic lymph node metastasis were demonstrated in6 patients, and the metastatic rate was 4.58%(6/131). (2) In univariate analysis , pathologic type, tumor grade, depth of myometrial invasion, peritoneal cytology and extrauterine spread were high risk factors . In multivariate analysis, the patients with special pathologic types or deep myometrial invasion or extrauterine spread had higher lymph node metastastic rate (p < 0.05); while in endometrioid carcinoma , the myometrial invasion and tumor grade were the most important risk factors. (3)Patients with no myometrium invasion had no lymph node metastais .With myometrial invasion≤50%, the patients with G3 had higher metastatic rate than G1/G2.(33.3% VS 2.53%, p=0.007). However , with deep myometial invasion, the metastatic rate of G1,G2,G3 was 25%,35%,50%, respectively, and there was no significant difference. (4)The obturator lymph nodes were the most common involved nodes.Conclusion: The patients with special pathologic type , deep myometrial invasion and extrauterine spread had higher lymph node metastastic rate and shoud undergo pelvic and paraaortic lymphadenectomy . Patients without myometrial invasion had no lymph node metastasis, and patiens with invasion