Study on peritoneal lymph node metastasis and high risk prognostic factors in advanced endometrial cancer
Objective To evaluate the risk factors associated with the prognosis and retroperitoneal lymph node(RLN)metastasis of advanced endometrial cancer(EC).Methods A total of 261 patients with advanced(stage Ⅲa-Ⅳb)pelvic lymph node(PLN)metastasis and para-abdominal aortic lymph node(PALN)metastasis(with/without PLN positivity)in the Gynecology Department of Sun Yat-sen University Cancer Center from January 2008 to December 2020 were included in the study.Logistic regression analysis was used to identify the related risk factors for the differences in PLN metastasis and PALN metastasis(with/without PLN positivity)in patients with advanced EC.Kaplan-Meier method was used to plot the survival curve.Log-rank and Cox regression were used to analyze the prognostic factors of patients and explore the factors that affect the prognosis of advanced EC.Results A total of 261 patients with stage Ⅲa-Ⅳb EC underwent total hysterectomy/extensive hysterectomy and RLN dissection(PLN dissection±PALN dissection).A total of 147 patients developed RLN metastasis,with an RLN metastasis rate of 56.32%.Age≥60 years(HR=2.51,P=0.013),neuron specific enolase(NSE)≥16.3 ng/mL(HR=2.20,P=0.039),poorly differentiated/dedifferentiated cancer(HR=2.21,P=0.010),muscle invasion depth≥1/2(HR=2.45,P=0.002),and lymphatic vessel infiltration(LVSI)(HR=4.03,P=0.001)were independent risk factors for RLN metastasis.The depth of muscle invasion≥1/2(HR=3.22,P=0.014)was an independent factor affecting the difference in the location of metastasis between PLN and PALN.The me-dian follow-up time was 67.7 months,the age was≥60 years(HR=2.57,P=0.001),NSE≥16.3 ng/mL(HR=2.02,P=0.006),ER non expression(HR=2.61,P=0.014),PR non expression(HR=2.00,P=0.016),muscle invasion depth≥1/2(HR=1.87,P=0.018),and LVSI(HR=2.30,P=0.001)were independent predictive factors for decreased overall survival.Conclusions Age≥60 years,NSE≥16.3 ng/mL,LVSI,poorly differentiated/dedifferentiated can-cer,and muscle invasion depth≥1/2 will increase the risk of RLN metastasis.Performing systematic RLN dissection is recommended for those patients.The risk of PALN metastasis increases with muscle invasion depth≥1/2.It is recom-mended to resection of RLN below the renal vein.Patients with age≥60 years,NSE≥16.3 ng/mL,no expression of ER or PR,muscle invasion depth≥1/2 and LVSI have poor overall survival,and active postoperative treatment is recommended.
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