Analysis Of The Risk Factors Of Lymph Node Metastasis Of Type Ⅰ Endometrial Carcinoma In Clinical Stage Ⅰ

ObjectiveType I endometrial carcinoma(EC)is the most common endometrial cancer,accounting for 80%of early endometrial cancer.Total hysterectomy+bilateral adnexectomy+pelvic and abdominal lymphadenectomy for patients with clinical stage I(i.e.confined to the uterine body)type I endometrial cancer can achieve surgical pathological staging and guide postoperative adjuvant treatment.However,extensive lymph node resection may lead to operative complications,such as intraoperative vascular and nerve injuries,postoperative deep venous thrombosis of lower extremity,lymphedema and lymphatic retention cysts,prolonged operation time and increased cost of treatment.According to Mayo criteria,about two-thirds of patients underwent unnecessary lymphadenectomy.Studies have shown that lymphadenectomy should not be performed in EC patients with low risk of lymph node metastasis(LNM)(grade 1-2,type I EC with lesions confined to endometrium or infiltrating myometrium<1/2).Although the risk of LNM in patients with early EC has been reported in many literatures,the internationally recognized risk standard of LNM has yet to be established.Due to the persistence of this controversy,the necessity and scope of lymphadenectomy for patients with early endometrial cancer are different in different countries and different studies.At present,there is a lack of unified guidelines to guide patients with early endometrial cancer for accurate surgical treatment.Therefore,it is of practical significance to explore the risk factors of lymph node metastasis in patients with early EC.The purpose of this study was to investigate the risk factors of LNM in patients with type I EC in clinical stage Ⅰ,and to provide valuable reference for patients with EC to choose individualized surgical scheme.MethodsA total of 548 EC patients with stage I clinical stage and type I endometrial carcinoma confirmed by Preoperative pathology as well as postoperative pathology in the First Affiliated Hospital of Zhengzhou University from January 2014 to September 2019 were retrospectively analyzed.The general data,examination and pathological data were collected,and Excel database was established.Statistical analysis was performed by Spss25.0 software.In univariate analysis,t-test was used when the quantitative data accorded with normal distribution,and Mann Whitney U-test was used when the quantitative data accorded with non normal distribution.Chi square test,chi square test with continuous correction or Fisher’s exact test were used for categorical variables for univariate analysis.The related continuous variables were included in ROC curve analysis to determine the best critical value for binary variables.Logistic regression was used for multivariate analysis.Results1.In this study,548 EC patients were treated with total hysterectomy+double appendectomy+pelvic lymphadenectomy,of which 356(65.0%)were treated with para aortic lymphadenectomy.The median number of pelvic lymphadenectomy was 17,ranging from 1 to 57.The median number of para aortic lymphadenectomy was 5,ranging from 1 to 38.There were 36 patients with lymph node metastasis,and the metastasis rate was 6.6%(36/548).33 patients with pelvic lymph node metastasis(PLNM),and the rate of pelvic lymph node metastasis was 6.0%(33/548).3 patients with para aortic lymph node metastasis(PANM),In 5 patients with pelvic and para aortic lymph node metastasis,the rate of para aortic lymph node metastasis was 2.2%(8/356).2.Univariate analysis of PLNM showed that the body mass index(BMI)of PLNM positive group was significantly lower than that of PLNM negative group(P<0.05).The levels of serum CA125,CA199,PLT and MONO in PLNM positive group were significantly higher than those in PLNM negative group(P<0.05).Low differentiation(G3),myometrial invasion(MI)≥ 1/2,cervical stromal involvement,positive peritoneal lavage fluid cells and lymphatic vascular space infiltration(LVSI)positive were associated with PLNM in clinical stage I patients with type I EC(P<0.05).Multivariate logistic regression analysis showed that BMI<26.28(kg/m2),serum CA199≥ 19.66(U/mL),MI≥ 1/2,LVSI positive and peritoneal lavage fluid cytology positive were independent risk factors for PLNM in clinical stage I EC patients with type I(P<0.05).ROC curve analysis showed that preoperative BMI,serum CA125,serum CA199,MONO indexes were statistically significant in judging AUC value of PLNM,The optimal cut-off values of these indexes were 26.28kg/m2,23.09U/mL,19.66U/mL and 0.395*109/L,respectively.The sensitivity and specificity of PLNM were moderate,the positive predictive value was low and the negative predictive value was high.The specificity and positive predictive value of serum CA199 were the highest,75.1%and 15.0%respectively;the sensitivity and negative predictive value of BMI were the highest,81.8%and 97.9%respectively.Comparing the status of PLNM of different pathological grades and different depth of muscle invasion,it was found that the positive rates of pelvic lymph nodes with lesions confined to intima,MI<1/2 and MI≥ 1/2 were 0.0%,5.7%and 23.2%respectively,showing a significant upward trend,and the difference was statistically significant.It was found that the positive rates of pelvic lymph nodes in pathological grade G1,G2 and G3 were 1.8%,6.5%and 20.4%respectively,showing a significant upward trend(P<0.05).3.Univariate analysis of PANM showed that MI≥1/2,LVSI positive,PLNM and elevated serum CA125 level were high risk factors for PANM in clinical stage I patients with type I EC patients with clinical stage I(P<0.05).Logistic regression analysis showed that LVSI positive and PLNM were independent risk factors for PANM in type I EC patients with clinical stage I(P<0.05).Conclusions1.BMI<26.28(kg/m2),serum CA199≥ 19.66(U/mL),MI≥1/2,LVSI positive and peritoneal lavage cytology positive were independent risk factors for PLNM in clinical stage I and type I EC patients.LVSI positive and PLNM were independent risk factors for PANM in type I EC patients with clinical stage I.2.The PLNM rate of EC patients increased significantly with the increase of pathological grade.The risk of PLNM was very low when EC patients were confined to the intima,while the risk of PLNM was significantly higher when MI<1/2 than when EC patients were confined to the intima.When MI≥1/2,the risk of PLNM was significantly higher than both.3.Paying attention to preoperative and intraoperative predictors to evaluate the LNM status of EC patients can help surgeons to take selective lymphadenectomy for EC patients,so as to achieve individualized and accurate treatment.