Analysis Of Risk Factors For Extra Uterine Metastasis In Endometrial Carcinoma

Background and ObjectiveEndometrial cancer is a common gynecological malignancies，and its worldwideincidence is rising year by year in recent years, Its incidence is higher than cervicalcancer in Europe and other developed countries, jumped to the first one.InChina,according to statistics, the incidence rate has become the first female genitaltract malignancies in Beijing and Shanghai, though it has lacked of exact incidencerate in the current,it has seriously affected on woman’s health and quality of life.Themain character of malignant tumors is metastasis,it is a major factor to affect thesurvival and prognosis of patients, extra uterine metastasis of endometrial cancerinclude lymph node metastasis, fallopian tubes metastasis,ovarian metastasis andperitoneal metastasis et al.With the development of modern medicine, the minimallyinvasive endoscopic technology are more widely applied in gynecological surgery,sothat more patients can be treated in the early stage. In2006, the FIGO announcedsurvival study results of the endometrial cancer patients from1962to2001, thesurvival rate has been increased from63%to80%. In order to further improve thesurvival rate of patients, they should be pay attention to the presence of risk factorsin addition to early diagnosis and proper treatment, the doctor should make accurateassessment of prognosis, formulate an individualized adjuvant therapy program, and try their best to improve the survival time of patient.This study aims to analyze the risk factors for extra uterine metastasis inendometrial cancer through retrospective analyzes the clinical,pathological andmolecular biological indicators of endometrial cancer cases and thus providing someguidance for the diagnosis and treatment of endometrial cancerMaterial and MethodsTotally149patients with endometrial cancer who were given thoroughlysurgical-pathologic staging procedure according to Obstetrics and Gynecology Unionin2009were collected from January2009to October2013in the Second AffiliatedHospital of Zhengzhou University. All those patients had not been given preoperativechemotherapy, radiotherapy and endocrine therapy before there were given surgeryand had no other merger tumors.Patients who were stage I were given fasciahysterectomy+double oophorectomy, pelvic lymph node and para-aortic lymph nodelymphadenectomy or sampling were given to these patients who had the risk factors(special pathologic type or poor differentiation of tissue cells) or had the suspectedenlargement pelvic and para-aortic lymph nodes. Patients who were stage II weregiven extensive or extensive secondary hysterectomy+double oophorectomy+pelvicand para-aortic lymph node lymphadenectomy.Patients who were stage III were givencytoreductive surgery.Retrospective analysis was carried on those patients about their age, menopausal,pathologic types, tumor grade, tumor size and EC risk factors (hypertension,diabetesand obesity). Retrospective analysis was carried on104cases of patients who weredetected by immunohistochemical SP method with estrogen receptor(estrogenreceptor, ER),103cases of patients with progesterone receptor(progesterone receptor,PR),104cases of patients with tumor protein53(tumor protein53, P53)and98casesof patients who were detected by radioimmunoassay with cancer antigen125(cancerantigen125, CA125)expression, analyzing the risk factors for extra uterinemetastasis in endometrial cancer.SPSS17.0software was used to analyzed the date by using Chisquare Test andFisher’s Exact Test. Multivariate analysis were used Logistic regression, P <0.05wasthought to be statistically significant. Results1. In this study, these patients age were from27to80years old, the average agewas56.53±9.047years old, there were104cases in menopausal, accounting for69.79%(104/149),there were45cases in premenopausal,accounting for30.21%(45/149).2.There were13cases who presented extra uterine metastasis, accounting for8.72%(13/149),there were7cases with lymph node metastasis, accounting for53.84%(7/13), followed by fallopian metastasis, accounting for23.07%(3/13), Theremaining3cases were for many parts of extra uterine metastasis.1cases hasmetastasis in the fallopian tubes,ovaries,mesentery and ascites,1cases has fallopiantubes and ovaries, metastasis,1cases has pelvic lymph node and peritoneal, metastasis.3. According to the univariate analysis, special pathologic type, tumor grade3,tumor size≥1/2, ER negetive, PR negetive,CA125positive and EC risk factors(hypertension,diabetes and obesity)had higher extra uterine metastatic rate(P<0.05).High-differentiated tissue, P53expression, menopause status and age onextra uterine metastases had no significant effect (P>0.05). According to theMultivariate Logistic regression analysis, special pathologic type, tumor grade3,tumor size≥1/2and EC risk factors (hypertension, diabetes and obesity) is not theindependent factors for the extra uterine metastasis in endometrial cancer(P>0.05).Conclusion1. Lymph node metastasis is the most common in endometrial cancer, followedby the fallopian tubes metastasis, a small number of patients showed the fallopiantubes, ovaries and peritoneal metastasesis.2. Special pathologic type, tumor grade3, tumor size≥1/2, ER negetive, PRnegetive,CA125positive and EC risk factors (hypertension,diabetes and obesity)were high factors for extra uterine metastasis in endometrial cancer.