| Background and ObjectiveEndometrial cancer(EC) is one of the three malignant tumors of female genitaltract.The incidence of endometrial cancer is an upward trend, so endometrial cancer isa serious threat to the women’s health.Endometrial cancer treatments mainly includessurgery, radiotherapy, chemotherapy, hormone therapy and biological treatment.FIGO(International Federation of Gynecology reported and Obstetrics) adopts the surgical-pathologic staging and emphasize the significance of lymph node excision of para-aortic lymphadenectomy.However, the value of systemic surgery staging is thetreatment or the judgement of prognosis, and the necessity and resection rang ofsystematic pelvic lymphadenectomy (PLD) and para-aortic lymphadenectomy(PALD) have been controversial.Lymph nodes are peripheral immune organs and arethe place that T cells and B cells settle down. Immune response occurs in the lymphnodes. Lymph nodes are involved in lymphocyte recirculation. So the removal of toomuch lymph nodes will destroy the integrity of the body’s immune system.It is worthconsiderable wether too much resection of negative lymph nedes will affect theprognosis. To explore the role of para-aortic lymphadenectomy in prognosis ofendometrial carcinoma,and the impact of lymph node number and negative lymphnode number on the prognosis of endometrial carcinoma and improve survival. Materials and methods:1.Source of materials: To analyse the clinical data of208patients who werediagnosed endometrial carcinoma and were accepted systematic pelvic or para-aorticlymphadenectomy in the Second Affiliated Hospital of Zhengzhou University fromJan.2004to Jun.2014. We checked outpatient records and made phone calls record toobtain follow-up results.If two methods could’t obtain the result,then lost the case.2.Prognostic indicator: recurrence and3-year survival rate and5-year survivalrate were used to evaluate the prognosis of patients.3.Statistical methods: We adopted SPSS17.0software for data analysis.Mean±standard deviation was the method to describe age and follow-up time.χ2testwas used to analyse the roles of para-aortic lymphadenectomy and lymph nodenumber and negative lymph node number on prognosis of endometrialcarcinoma.Pearson correlation coefficient described the dependency of lymph nodenumber and negative lymph node number.Logisitic regression analysis was used toanalyse the role of para-aortic lymphadenectomy and postoperatie adjuvant therapyand negative lymph node number on prognosis of endometrial carcinoma.Life tablewas used to analyze the survival rate.α＝0.05is considered to be as the detectionstandard.Used a two-sided distribution,P＜0.05is defined as a statistically significantdifference.Results:1.For stage Ⅰ and stage Ⅱ endometrial carcinoma patients,there was nostatistically significant difference between two groups of resection of para-aorticlymph nodes and no para-aortic lymphadenectomy（P=0.475＞0.05，P=0.052＞0.05）.For stage Ⅲendometrial carcinoma patients,there was statistically significantdifference between two groups of resection of para-aortic lymph nodes and nopara-aortic lymphadenectomy（P=0.016＜0.05）.For overall, there was statisticallysignificant difference between two groups of resection of para-aortic lymph nodesand no para-aortic lymphadenectomy（P=0.034＜0.05）.As there were only2casesstage Ⅳ, and they were accepted para-aortic lymph nodes dissection, so there was nostatistical analysis.2.For stage Ⅰ and stage Ⅱ endometrial carcinoma patients,there was no statistically significant difference between two groups of the number of lymph node≥20and the number of lymph node＜20（P=0.298＞0.05，P=0.640＞0.05）.For stageⅢ endometrial carcinoma patients,there was no statistically significant differencebetween two groups of the number of lymph node≥20and the number of lymph node＜20（P=0.008＜0.05）.For overall,there was no statistically significant differencebetween two groups of the number of lymph node≥20and the number of lymph node＜20（P=0.263＞0.05）.As there were only2cases stage Ⅳ, and the number of nodewere no less than20, so there was no statistical analysis.3.For stage Ⅰ and stage Ⅱendometrial carcinoma patients,there was nostatistically significant difference between two groups of the number of negativelymph node≥20and the number of negative lymph node＜20（P=0.298＞0.05，P=0.640＞0.05）. For stage Ⅲ endometrial carcinoma patients, there was nostatistically significant difference between two groups of the number of negativelymph node≥20and the number of negative lymph node＜20（P=0.047＜0.05）.Foroverall, there was no statistically significant difference between two groups of thenumber of negative lymph node≥20and the number of negative lymph node＜20（P=0.190＞0.05）. As there were only2cases stage Ⅳ, and the number of negativenode was no less than20, so there was no statistical analysis.4.Negative lymph node and the total number of lymph nodes had positivelycorrelated, and correlation cofficient r=0.971,P=0.000＜0.05.5.Para-aortic lymphadenectomy, postoperative adjuvant therapy and negativelymph node number≥20were the factors of recurrence rate of endometrial carcinoma(P <0.05), and these could reduce the recurrence rate(OR＜1).6.In this study,20(9.76%) of207patients had intraoperative or postoperativecomplications. In the PALD group, there were16patients(17.39%) withcomplications, and there were4patients(3.54%) with complications in the no PALDgroup. There was statistically significant differences in complication incidencebetween two groups (P=0.001＜0.05).7.In PALD+PLD group,3-year surival rate of patients with stage Ⅰ andⅡwere100%.5-year surival rate of patients with stage Ⅰ and Ⅱ were100%and96%.3-year surival rate and5-year surival rate of patients with stage Ⅲwere93% and72%. In PLD group,3-year surival rate and5-year surival rate of patients withstage Ⅰ were100%.3-year surival rate and5-year surival rate of patients with stageⅡ were98%and80%.3-year surival rate and5-year surival rate of patients withstage Ⅲ were77%and68%. In negative lymph nodes≥20group,3-year surival rateand5-year surival rate of patients with stage Ⅰa nd Ⅱ were100%.3-year surival rateand5-year surival rate of patients with stage Ⅲ were92%and75%. In negativelymph nodes<20group,3-year surival rate and5-year surival rate of patients withstage Ⅰ were100%.3-year surival rate and5-year surival rate of patients with stageⅢ were76%and67%.As there were only2cases stage Ⅳ, and they were acceptedpara-aortic lymph nodes dissection and the number of negative node was no less than20, so there was no analysis.Conclusion:1.The ideal para-aortic lymphadenectomy reduces the recurrence rate of stage Ⅲendometrial carcinoma patients. However, it can’t obviously improve the prognosis ofstage Ⅰa nd stage Ⅱendometrial carcinoma patients.2.The number of the total number of lymph nodes≥20could reduce therecurrence rate of stage Ⅲ endometrial carcinoma patients.And the number of thenegative lymph nodes≥20does not affect the surival. |
PDF Full Text Request