病理原发肿瘤因素与子宫内膜腺癌患者盆腔和主动脉旁淋巴结受累的风险相关

IF 0.5 4区 医学 Q4 OBSTETRICS & GYNECOLOGY European journal of gynaecological oncology Pub Date : 2023-01-01 DOI:10.22514/ejgo.2023.056
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引用次数: 0

摘要

子宫内膜腺癌(EAC)患者淋巴结(LN)阳性的存在指导了辅助治疗,但关于初次手术时淋巴结评估的建议仍然存在差异。原发性病理肿瘤特征可以预测有限LN评估的EAC患者LN累及的风险。纳入了2004-2016年期间在国家癌症数据库中诊断为病理性T1-T2 EAC的患者,这些患者在手术时至少有一个淋巴结样本。使用逻辑回归确定LN累及的病理原发肿瘤预测因子。为了预测总体、仅盆腔、主动脉旁和/或盆腔淋巴结受累情况,生成了图。在57810例EAC患者中,4002例为淋巴结阳性。在多变量分析中,增加病理肿瘤类别(pT2 vs pT1a),优势比(OR) 5.43, 95%可信区间(CI) 4.89-6.02, p <0.001),增加病理肿瘤分级(3级对1级,OR 1.62, 95% CI 1.47-1.79, p <0.001),每厘米肿瘤大小增加(OR 1.05, 95% CI 1.04-1.06, p <0.001),存在淋巴血管侵犯(LVI) (OR 6.33, 95% CI 5.87-6.83, p <0.001)预测总体LN阳性。LVI的存在是主动脉旁淋巴结受累的一个更强的预测因子(OR 6.43, 95% CI 5.55-7.47, p <0.001)比盆腔淋巴结受累(OR 5.42, 95% CI 4.98-5.90, p <0.001)。对于LN评估有限的患者,可使用病理肿瘤特征来评估盆腔或主动脉旁LN累及的风险。这些信息可以为辅助治疗决策提供信息,并指导未来的研究。
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Pathologic primary tumor factors associated with risk of pelvic and paraaortic lymph node involvement in patients with endometrial adenocarcinoma
The presence of lymph node (LN) positivity in endometrial adenocarcinoma (EAC) patients guides adjuvant treatment, but recommendations regarding LN evaluation at the time of primary surgery remain variable. Primary pathologic tumor characteristics may predict risk of LN involvement in EAC patients with limited LN evaluation. Patients diagnosed between 2004–2016 with pathologic T1–T2 EAC in the National Cancer Database who had at least one lymph node sampled at the time of surgery were included. Pathologic primary tumor predictors of LN involvement were identified using logistic regression. To predict overall, pelvic only, and paraaortic and/or pelvic LN involvement, nomograms were generated. Among 57,810 EAC patients included, 4002 were node positive. On multivariable analysis, increasing pathologic tumor category (pT2 versus pT1a, odds ratio (OR) 5.43, 95% confidence interval (CI) 4.89–6.02, p < 0.001), increasing pathologic tumor grade (grade 3 versus grade 1, OR 1.62, 95% CI 1.47–1.79, p < 0.001), increase in tumor size per centimeter (OR 1.05, 95% CI 1.04–1.06, p < 0.001), and presence of lymphovascular invasion (LVI) (OR 6.33, 95% CI 5.87–6.83, p < 0.001) were predictive of overall LN positivity. The presence of LVI was a stronger predictor of paraaortic LN involvement (OR 6.43, 95% CI 5.55–7.47, p < 0.001) than pelvic LN involvement (OR 5.42, 95% CI 4.98–5.90, p < 0.001) in multivariable analysis. For patients with limited LN evaluation, pathologic tumor features can be used to estimate the risk of pelvic or paraaortic LN involvement. This information may inform adjuvant treatment decisions and guide future studies.
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来源期刊
自引率
25.00%
发文量
58
审稿时长
1 months
期刊介绍: EJGO is dedicated to publishing editorial articles in the Distinguished Expert Series and original research papers, case reports, letters to the Editor, book reviews, and newsletters. The Journal was founded in 1980 the second gynaecologic oncology hyperspecialization Journal in the world. Its aim is the diffusion of scientific, clinical and practical progress, and knowledge in female neoplastic diseases in an interdisciplinary approach among gynaecologists, oncologists, radiotherapists, surgeons, chemotherapists, pathologists, epidemiologists, and so on.
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