Analyze Clinicopathologic Featues Of Pelvic Lymph Node And Para-arotic Lymph Node Metastasis In Endometrial Carcinoma

Objective: Endometrial cancer is one of the most common malignant tumor in the female reproductive system,which derived from the endometrium and accounts for 20-30% of all female reproductive system tumor.Moreover,the endometrial carcinoma has a rising morbidity in worldwide and in many western developed countries,the incidence of endometrial carcimoma is at the top of reproductive system malignangt tumor.Lymph node metastasis is a very important factor which can affect the prognosis of patients with endometrial carcinoma.And pelvic lymph node metastasis and para-arotic lymph node metastasis have different implications in endometrial carcinoma.The article aims to analyze retrospectively the clinicopathological characters of patients with endometrial carcinoma,to evaluate the related factors of the pelvic lymph node metastasis and para-arotic lymph node metastasis in endometrial carcinoma.Methods: The data of 1445 patients with endometrial carcinoma underwent primary surgical treatment and confirmed by pathology from Jan 2008 to Dec 2014 in the Fourth Hospital of Hebei Medical University were reviewed and analyzed retrospectively.The scope of the survey included the uterus,bi-accessories and lymph node excision.An Excel database was built with clinical follow-up and analyzed the related factors of the endometrial carcinoma.SPSS16.0 statistical software was applied.Univariate analysis were estimated by Chi square and Fisher exact tests,Multiple analysis were estimated by Logistic regression mode.Results:1 The study included 1445 patients with endometrial carcinoma.The average age of 1445 patients was 53.76±8.375 years old(28-77 years old),the median age was 55 years old,<55(720 cases)acounted for 49.8%,?55(725 cases)acounted for 50.2%.Postmenopausal cases were 884(61.2.%),cases of premenopausal were 561(38.8%);the average age of postmenopausal was 57.54 yeas old(57.54±6.757 years old).BMI<25 Kg/m2(454csaes)accouted for31.4%,BMI?25Kg/m2(991 casses)accounted for 68.6%.The average BMI was 26.28±4.0311 Kg/m2(15-49 Kg/m2).There were 1052 cases of simple vaginal bleeding,accounted for 72.8%,103 cases of abnormal vaginal drainage(7.1%);124 cases of menstrual disorder(8.6%);166 cases of no symptoms or low-abdominal mass(11.5%).There were 194cases(13.4%)of malignant tumor in first-degree relatives,included endometrial carcinoma 4cases,ovarian cancer 2 cases,cervical cancer 2 cases,esophagus cancer 48 cases,cardiac carcinoma 10 cases,gastric cancer 40 cases,lung cancer 39 cases,breast cancer 6 cases,liver cancer 20 cases,rectal cancer 10 cases,pancreatic cancer 6 cases,thyroid cancer 1 case,kidney cancer 1 case,gingival cancer 1 case,gallbladder cancer 1 case,laryngocarcinoma 1 case,hematological malignant tumor 2 cases.The cases combined with hypertension were 461cases(31.9%),111 cases combined with diabetes(7.7%),61 cases combined with both(4.2%),69 cases combined with infertility(4.8%).2 There were 170 cases of laparotomy,accounted for 53.3%,laparoscope 675 cases accounted for 46.7%.79 cases of high cell differentiation(5.5%),1097 cases of middle cell differentiation(75.9%),269 cases of low cell differentiation(18.6%).Cases of no or superficial myometrial invasion(1002 cases)accounted for 69.3%,deep invasion(296 cases)accounted for 20.5%.vascular invasion accounted for 6.6%(95 cases),no vasculer invasion accounted for 93.4%(1350 cases).277 cases of cervical stromal invasion(19.2%).1168 cases of non-cervical stromal invasion(80.8%).Cases of accessory metastasis(76 cases)accounted for 5.3%.341 cases of CA125?35U/ml(23.6%).1047 cases of stage?(72.5%),211 cases of stage(14.6%)?,176 cases of stage(12.2%)?,11 cases of stage ?(0.7%).1366 cases of endometriod carcinoma(94.5%),79 cases were non-endometriod carcinoma(5.4%),7 cases of mixed adenocarcinoma,35 cases of serous adenocarcinoma,23 cases of clear cell carcinoma,5 case of small cell carcinoma,9 case of mucinous adenocarcinoma.3 There were 1445 patients with endometrial carcinoma,109 cases of positive lymph node,77 cases with positive pelvic lymph node metastasis and negitive para-arotic lymph node metastasis,accounted for70.6%,13 cases with positive para-arotic lymph node metastasis and negitive pelvic lymph node,accounted for 11.9%,13 cases with both positive pelvic and para-arotic lymph node metastasis,accounted for 17.4%.Conclusion:1 BMI,CA125,grade,myometrial invasion,vascular invasion,cervical stromal invasion,accessory metastasis,histological type,surgical way are related factors of pelvic lymph node and para-arotic lymph node metastasis with endometrial carcinoma.2 Deep myometrial invasion,vascular invasion,accessory metastasis are independent factors of pelvic lymph node and para-arotic lymph node metastasis with endometrial carcinoma.3 Pelvic lymph node is more prone to metastasis than para-arotic lymph node.