| Objective:To explore the risk factors of retroperitoneal lymph node metastasis in patients with stage I endometrioid adenocarcinoma,to construct a model equation for predicting lymph node metastasis before operation and to conduct preliminary tests,and to evaluate the risk of individual lymph node metastasis before operation and to determine the high risk population before operation.To provide a basis for the selection of surgical methods and adjuvant therapy for patients with stage I endometrioid adenocarcinoma.Methods:The clinical data of 428 patients with stage I endometrioid adenocarcinoma treated in the Department of Gynecology of the first affiliated Hospital of Wannan Medical College from January 2013 to July 2020 were collected and screened,and 259 patients met the criteria in this study.Univariate analysis was used to analyze the correlation between clinicopathological indexes and lymph node metastasis in 259 patients before operation.The independent risk factors affecting lymph node metastasis were found by logistic multivariate analysis,and the risk prediction model equation was constructed.Hosmer-Lemeshow test method was used to test the model equation.Results:1.A total of 259 patients who met the criteria were enrolled in this study.And 24patients with retroperitoneal lymph node metastasis were found in postoperative pathological examination,with a lymph node metastasis rate of 9.3%（24/259）.Among the 24 patients,17cases only had pelvic lymph node metastasis,1 case had only abdominal para-aortic lymph node metastasis,and 6 cases had pelvic and abdominal para-aortic lymph node metastasis at the same time.The rate of pelvic lymph node metastasis was 8.9%（23/259）,and that of para-aortic lymph node metastasis was only 2.7%（7/259）.2.The results of univariate analysis showed that the preoperative high levels of HE4（pmol/L）,CA125（U/ml）,NEUT（109/L）,the maximum diameter of tumor on MRI（cm）,the low level of LY（109/L）,the depth of myometrial invasion indicated by MRI≥1/2,and the histological grade of endometrial biopsy showed that the negative expression of HG3 and PR had certain statistical significance on lymph node metastasis.Therefore,it can be concluded that these indexes are related to retroperitoneal lymph node metastasis in patients with stage I endometrioid adenocarcinoma（P<0.05）.However,the age,menopause,BMI,WBC,NLR,MLR,HGB and PLT in whole blood cells and the expression of ER,P53 and P16 in whole blood cells and the expression of ER,P53 and P16 in biopsy pathology had no effect on retroperitoneal lymph node metastasis in patients with stage I endometrioid adenocarcinoma.3.The values of CA125 and HE4 were analyzed by the working curve of ROC subjects,and the results showed that the area under the ROC curve of CA125 for judging retroperitoneal lymph node metastasis was 0.743,P=0.000,which was statistically significant.The best cut-off value of CA125 selected according to YOUDENG index was 33.15U/ml,sensitivity was 0.667,specificity was 0.813,positive predictive value was 66.67%and negative predictive value was81.28%.The area under the ROC curve of HE4 for judging retroperitoneal lymph node metastasis was 0.811,and the best cut-off of HE4 selected according to YOUDENG index was95.40 pmol/L,sensitivity was 0.750,specificity was 0.851,the positive predictive value was75.00%,and the negative predictive value was 85.11%.The area under the ROC curve of CA125combined with HE4 in the diagnosis of retroperitoneal lymph node metastasis was 0.850,sensitivity was 0.792,specificity was 0.817.4.Multivariate analysis showed that HG3（OR=2.558,95%CI:1.078～6.068,grade 0.033）and high serum HE4 level（OR=1.004,95%CI:1.001～1.006,0.006）were independent risk factors for lymph node metastasis of stage I endometrioid adenocarcinoma.The independent risk factors were analyzed by logistic regression analysis,and the model regression equation was obtained as follows:Y=-0.248+0.939 X1+0.004 X2（Y:lymph node metastasis rate,X1:histological grade,X2:HE4pmol/L）.After Hosmer-lemeshow goodness-of-fit hypothesis test,P>0.05.Conclusion:1.The rate of retroperitoneal lymph node metastasis in stage I endometrioid adenocarcinoma is low,and pelvic lymph node metastasis is common,and it can spread directly from the uterus to the para-abdominal aortic lymph nodes through jumping metastasis.2.Preoperative high levels of HE4（pmol/L）,CA125（U/ml）,NEUT（109/L）,the largest tumor diameter on MRI（cm）,low level of LY（109/L）,MRI indicated that the depth of myometrial invasion≥1/2,histological grade of endometrium was HG3 and negative expression of PR were risk factors for lymph node metastasis of stage I endometrioid adenocarcinoma.Histological grade HG3 and high serum HE4 levels are independent risk factors for lymph node metastasis of stage I endometrioid adenocarcinoma.3.In the diagnosis of retroperitoneal lymph node metastasis in patients with stage I endometrioid adenocarcinoma,the sensitivity,specificity,negative predictive value and positive predictive value of HE4 were higher than those of CA125.Combined HE4 with CA125 in the diagnosis of retroperitoneal lymph node metastasis,the area under the curve was the largest and the sensitivity was the highest.4.The predictive model equation before operation wasY=-0.248+0.939 X1+0.004 X2（Y:lymph node metastasis rate,X1:histological grade,X2:HE4pmol/L）.After Hosmer-lemeshow test,P>0.05,the goodness of fit of the model is high.The model equation has certain clinical significance in predicting lymph node metastasis of stage I endometrioid adenocarcinoma.when the preoperative serum HE4 is low and the pathology of endometrial biopsy indicates that the risk of lymph node metastasis is relatively low in patients with stage I endometrial carcinoma with histological grade HG1 or HG2. |
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