Analysis Of High-risk Factors In Pelvic And Para-aortic Lymph Node Metastasis In Endometrial Cancer

Objective:The aim of this study is to explore the relevant risk factors of pelvic lymph node(PLN) and para-aortic lymph node(PALN) metastasis masculine in endometrial cancer.Methods:Totally 214 patients with endometrial carcinoma who were diagnosed endometrial cancer at FIGO StageⅠ—Ⅳfrom Jan 2008 to Dec2010 in Shandong university Qilu hospital were recruited. All patients underwent hysterectomy, bilateral salpingo-ophorectomy(TH+BSO), and optional pelvic lymphadenectomy (PLA) and/or para-aortic lymphadenectomy (PALA).150 patients performed lymphadenectomy. We retrospectively studied clinical and patho-information to count lymph node metastasis rate to find risk factors of Pelvic node (PLN) and para-aortic lymph node(PALN) metastasis as to avoid such excessive treatment and supplying reference for deciding surgical extent in endometrial cancer.Results:Of the 214 patients perforomed surgical therapy.150 patients undertaken hysterectomy and bilateral salpingo-oophorectomy(TH+BSO) with pelvic lymphadenectomy (PLA) and/or para-aortic lymphadenectomy (PALA). We evaluated 150 patients who had PLA with or without PALN.71 patients had PLA plus PALA and 79 patients underwent only PLA. Of the 150 patients 12(8%) had lymph node metastasis. Of the total 12 patients who had lymph node(LN) metastasis:Pelvic lymph node(PLN) metastasis rate occurred in 7.33%(11/150) with. Para-aortic lymph node(PALN) metastasis rate occurred in 4.23%(3/71).PLN and PALN metastasis rate occurred in 2.82%(2/71). Isolated PALN metastasis occurred in 1.41%(1/71). In endometrioid carcinoma, lymph node metastasis nate occurred in 4.69%(6 /128), PALN metastasis rate occurred in 3.17%(2/63), while in patients with special pathologic type, the rate was 27.27%(6/22), PALN metastasis rate occurred in 12.5%(1/8). In endometrioid carcinoma PLN metastasis rate were Gl:0%(0/60), G2:7.55%(4/53), G3:13.44%(2/15), PALN metastasis rate were Gl:0%(0/32), G2:8.70%(2/23), G3:12.5%(1/8). In endometrioid carcinoma PLN metastasis rate was 0.96% of myomctrial invasion <l/2 myomctrial invasion≥1/2 the rate was 16.67%(5/24), PALN metastasis rate was 0%(0/47)and 18.75%(3/16)respectively.In univariate analysis, that special pathologic type, tumor grade 2 and 3, depth of myomctrial invasion, predicted pelvic lymph node(PLN)metastasis significandy. Special pathologic type, tumor grade 3, depth of myomctrial invasion, lymphovascular space invasion (LVSI) other extrauterinaland PLN metastasis was closely related with PALN metastasis. The iliac vessels lymph nodes were the most common involved nodes. Multivariate analysis revealed that special pathologic type, tumor grade 3, depth of myomctrial invasion were risk factors of PLN metastasis. PLN metastasis was closely related with PALN metastasis.Conclusion:1. Toal lymph node metastasis rate occurred in 8%(12/150). Pelvic node(PLN) metastasis rate occurred in 7.33%(11/150) Para-aortic node(PALN) metastasis rate occurred in 4.23%(3/71). PLN and PALN metastasis rate occurred in 2.82%. Isolated PALN metastasis occurred in 1.41%(1/71).2. In endometrioid carcinom, lymph node metastasis occurred in 4.69%(6/128), PALN metastasis rate occurred in 3.17%(2/63), while in patients with special pathologic type, the rate was 27.27%(6/22), PALN metastasis rate occurred in 12.5%(1/8).3. The iliac vessels lymph nodes were the most common involved nodes. The second were obturator lymph node. The third were Para-aortic node.4. This study introduced the concept of specific factors including special pathologic type, tumor grade 2 or 3, depth of myometrial invasion, lymphovascular space invasion (LVSI), and other evidence of extra-uterine disease to predict for PLN metastases. Tumor grade 3, deep myometrial invasion, other extrauterinal spread and PLN metastases are high risk factors for PALN metastasis. PLN metastasis is one significant risk factor for PALN metastasis.5. The myometrial invasion and tumor grade were the most important risk factors.To the patient in endometrial cancer with tumor grade 1, had no lymph node metastasis,myometrial invasion <l/2 pelvic lymph node metastasis rate were low to 0.96%(1/104), and no para-aortic lymph node metastasis. These patients could avoid lymphadenectomy.6. Lymph node can metastasis readily to PALN.While isolated PALN metastasis rate occurred in only 1.41%(1/71).