Analysis Of Lymph Node Metastasis And Risk Factors In Endometrial Carcinoma

Objective:Knowledge of the risk factors for lymph node metastasis(LNM)is necessary to treat patients with endometrioid uterine cancer to optimize and further individualize treatment.The aim of this study is to explore the lymph nodes metastasis of endometrial carcinoma and risk factors in order to determine surgical method.Methods:The clinical pathological data of 1724 patients endometrial carcinoma who underwent complete stage operation from January 2000 to December 2016 were retrospectively analyzed.The scope of this study included the clinical pathological data,detailed history and postoperative pathology.An Excel database was created by clinical data.SPSS 20.0statistical software was applied.The single factor analysis was performed by Chi square test,and the multivariate analysis was analyzed by Logistic regression.The significance level for all analyses was set at 0.05.Results:1 In this study,1724 patients with endometrial cancer who underwent laparotomy or laparoscopic complete staging were included.There were 571 cases with no menopause,accounting for 33.1%,1153 cases with menopause accounted for 66.8%.There were 95 cases without birth history,accounting for 5.5%.There were 1664 cases(96.5%)with estrogen-dependent pathological types and 60 non-estrogen-dependent cancers.Pathological grades were 104 cases with well-differentiated G1,accounting for 6.0%,1175 cases with moderately differentiated G2,accounting for 68.2%,445 cases with poorly-differentiated G3,accounting for 25.8%.Preoperative tumor markers CA125?35U/ml were 101 cases,accounting for 35.6%,preoperative HE4?140pmol/L were 27 cases,accounting for 26.2%.There were 64 cases with positive peritoneal lavage fluid,accounting for 4.5%,1245 cases with tumor size ? 2cm,accounting for 72.2%,242 cases with muscular ingrowth depth ? 1/2,accounting for 14.0%,117 cases with vascular positive disease,accounting for 6.8%Cervical involvement in 308 cases,accounting for 17.8%,attachment involvement in 68 cases,accounting for 3.9%,vaginal or parametrial involvement in 15 cases,accounting for0.8%.2 There were 160 cases of pelvic lymph node or abdominal aortic lymph node metastasis in 1724 patients,and the lymph node metastasis rate was 9.28%.There were 151 cases of pelvic lymph node metastasis(8.76%)and 39 cases of para-aortic lymph node metastasis(2.26%).Pelvic lymph node metastasis with obturator lymph node,especially right metastasis was the most common,the metastatic rate was 5.33%(92/1724).The secondwas the external iliac lymph node with a metastasis rate of 4.23%.There were 124 patients with positive lymph nodes in 2 groups and more than 2 groups.The metastasis rate was77.5%.3 Among the 39 patients with para-aortic lymph node metastasis,only PAN was transferred,and 30 cases were combined with PLN transfer(76.92%).4 Univariate analysis showed lymph node metastasis and no reproductive history,non-endometrioid carcinoma,G3,preoperative CA125?35 U/ml,myometrial invasion depth?1/2,cervical involvement,vaginal or parametrial involvement,accessory involvement Positive vasculature was related(P<0.05).Logistic multivariate analysis showed that no reproductive history,non-endometrioid carcinoma,G3,CA125?35 U/ml,myometrial invasion depth ?1/2,and cervical involvement were independent risk factors for lymph node metastasis(P<0.05).Among them,poor differentiation and muscular infiltration depth ? 1/2were significantly associated with lymph node metastasis(P<0.01).5 Univariate analysis of 39 patients with PALN metastases showed non-endometrioid carcinoma,G3,myometrial invasion depth ?1/2,cervical involvement,vaginal or parametrial involvement,accessory involvement,vasculitis positive,PLN positive was a risk factor for PALN metastasis(P<0.05).Multivariate analysis showed that non-endometrioid carcinoma,G3,myometrial infiltration depth?1/2,PLN positive and PALN metastasis were significantly correlated(P<0.05).6 Among the 1724 patients,35 patients with pathological grade G1 or G2 combined with less than 1/2 depth of muscle infiltration had lymph node metastasis,and the metastasis rate was 3.1%(35/1130).There were 59 cases of lymph node metastasis in patients with G3 combined with deep muscular infiltration,with a metastasis rate of 63.4%(59/93).Conclusions:1 Endometrial cancer is more likely to have pelvic lymph node metastases.Obturator lymph node metastasis is most common in lymph node metastasis.There were multiple PLN metastases in the para-aortic lymph node.2 No reproductive history,non-estrogen-dependent,G3,CA125?35 U/ml,deep myometrial invasion,and cervical involvement are independent risk factors for LNM.3 There was significantly associated with lymph node metastasis between G3 and deep myometrial invasion.Preoperative evaluation of pathological grade was G1 or G2 combined with muscle layer infiltration < 1/2 patients may have the minimum risk of lymph node metastasis.4 For patients who have no fertility requirements,no high-risk complications,and can tolerate surgery,it is recommended to perform comprehensive staging.For those with high-risk factors,a full-scale surgery must be performed.For patients who cannot tolerate surgery,lymph node sampling should be performed and the preferred range of lymph node sampling is obturator and external iliac lymph nodes.