| Background and ObjectiveComprehensive staging surgery is endometrial cancer(endometrial cancer,EC)an important way of the operation,overall,patients with endometrial cancer of lymph node metastasis rate low and more likely to occur in patients undergoing lymphadenectomy systemic disease associated with surgery,so whether to all patients,especially in patients with early EC conventional systemic lymph node resection is controversial.Lymphatic fluid collected from different parts of the uterus has different reflux routes.Lymphatic reflux in the fundus and cornus of the uterus directly flows into para-aortic lymph nodes without passing through pelvic lymph nodes,resulting in skipped lymph node metastasis.Precise preoperative judgment of lesion range and location and the presence of distant metastasis will affect the choice of surgical range.In order to avoid excessive lymph node dissection and postoperative complications associated with systemic lymphadenectomy,This study analyzed and evaluated the risk factors of endometrial carcinoma lymph node metastasis and the problem of lymph node skipping metastasis,in order to provide a basis for the selection of surgical scope before surgery.methodsFrom January 2015 to December 2020,because of EC in our comprehensive staging surgery namely complete hysterectomy,bilateral ovaries,fallopian tube,lymph node cleaning operation and clinical data of 263 cases,tumor site were retrospectively analyzed and other relevant factors relationship with lymph node metastasis parts and preoperative Magnetic Resonance Imaging(MRI)to predict the reliability of the results of tumor site.SPSS 25.0 statistical software was used for data processing and analysis.The chi-square test or Fisher exact probability method was used for univariate analysis of count data,and the Logistic regression model was used for multivariate analysis of significant factors.P<0.05 was considered statistically significant.Results1.The rate of lymph node metastasis in 263 patients was 11.79%(31/263),the rate of pelvic lymph node metastasis was 11.41%(30/263),the rate of para-aortic lymph node metastasis was 7.98%(21/263),and the rate of skip lymph node metastasis was 0.43%(1/233).2.The serum CA125 level,the cytology of abdominal rinse fluid,the degree of differentiation,the pathological type,the depth of muscular infiltration,cervical interstitial involvement,vaginal or parauterine involvement,adnexal metastasis,and lymphvsacular space invasion were associated with pelvic lymph node metastasis(P<0.05).The level of serum CA125,cytology of abdominal rinse fluid,degree of differentiation,pathological type,depth of muscular invasion,cervical interstitial involvement,adnexal metastasis and lymphvsacular space invasion were correlated with para-aortic lymph node metastasis(P<0.05).3.The lymph node metastasis rate was 38.64%(17/44)when the tumor involved the cervix,which was significantly higher than the rate of 6.85%(10/146)when the tumor was confined to the uterine body or 5.48%(4/73)when the tumor was confined to the uterine fundus and uterine angle,with statistical significance(P<0.05).4.The accuracy of preoperative magnetic resonance examination was 37/46(80.43%)when the tumor involved the cervix,63/63(100.00%)when the tumor was confined to the uterine fundus and uterine angle,and 137/154(88.96%)when the tumor was confined to the uterine body.Conclusions1.Tumor involvement in the cervix,low differentiation,non-endometrioid adenocarcinoma,deep muscular infiltration,lymphvsacular space invasion,positive peritoneal cytology,elevated serum CA125 level and other factors are associated with lymph node metastasis.2.The site of the tumor is related to lymph node metastasis,and the lymph node metastasis rate is high when the tumor involves the cervix.When tumor site at the bottom of the uterus may occur skip lymph node metastasis.3.Preoperative magnetic resonance examination is of high value in predicting tumor site,and can provide basis for the selection of treatment plan. |
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