Correlation Analysis Between Lymph Node Metastasis And Survival Prognosis Of Endometrial Cancer With Clinical Pathological Characteristics

Objective:This study retrospectively analyzes the cases of patients undergoing surgical treatment in our hospital,discusses the correlation between LNM and survival prognosis with clinical pathological characteristics of endometrial cancer patients,studies its clinical application value,and provides reference for evaluating the preoperative and intraoperative LNM status,formulating effective and reasonable surgical plan,and evaluating patient prognosis.Methods:The clinical-pathological and survival data of 561 patients with endometrial cancer who were hospitalized and received surgical treatment in the gynecology department of the First Affiliated Hospital of Anhui Medical University from January 2008 to August2020 were collected and collated.Statistical analysis was processed using SPSS 22.0software.Results:1.Among the 561 EC patients in this study,426 EC patients underwent lymphadenectomy during surgery,of which 250 patients merely underwent pelvic lymphadenectomy and 176 patients underwent pelvic lymphadenectomy + para-aortic lymphadenectomy.Postoperative pathological results showed that a total of 39 patients had LNM.The total rate of LNM was 9.2%(9/426).The rate of pelvic lymph node metastasis was 8.9%(38/426),of which the rate of the left pelvic lymph node metastasis was 7.5%(35/426),the rate of the right PLN metastasis was 4.0%(17/426),and the rate of the two-sided pelvic lymph node metastasis was 2.6%(11/426).The rate of pure pelvic lymph node metastasis was 7.5%(32/426).The rate of para-aortic lymph node metastasis was 1.6%(7/426),of which 85.7%(6/7)PALN metastasis accompanied with PLN metastasis,and The rate of pure PALN metastasis was 0.2%(1/426).2.The results of univariate analysis of pelvic lymph nodes metastasis showed that preoperative serum CA-125 level,pathological type,pathological grading,myometrial invasion,cervical invasion,and LVSI associated with PLN metastasis in EC patients(P<0.05).Age,BMI,ascites,preoperative MRI were not associated with pelvic lymph node metastasis in EC patients(P>0.05).Multivariate analysis showed that preoperative serum CA-125≥35U/ml,cervical invasion positive,and LVSI positive were independent factors of PLN metastasis.The results of the relationship between the presence and number of independent risk factors and the rates of PLN metastasis showed that the rate of PLN metastasis was increased significantly with the increase of the number of independent risk factors.3.The results of univariate analysis of para-aortic lymph node metastasis showed that preoperative serum CA125 level,pathological grading,lymphovascular space invasion,preoperative MRI,PLN metastasis(including left PLN metastasis and right PLN metastasis)were associated with PALN metastasis in EC patients(P<0.05).Age,BMI,pathological type,myometrial invasion,cervical invasion,ascites were not associated with PALN metastasis in EC patients(P>0.05).Multivariate analysis showed that PLN metastasis,including left PLN metastasis and right PLN metastasis,were independent risk factors of PALN metastasis.According to the relationship between PLN and PALN metastasis,when there was no PLN metastasis,the rate of PALN metastasis was 0.6%.Therefore LNM of EC patientst could be the pattern of skip metastasis.when there is PLN metastasis,such as only left PLN metastasis,the rate of PALN metastasis was 42.9%;such as only the right PLN metastasis,the rate of PALN metastasis was 33.3%;such as the two-sided PLN metastasis,the rate of PALN metastasis was 100%.4.The characteristics of clinical cases were divided into groups,and the relationship between their characteristics and survival time was analyzed by Kaplan-Meier method..The overall average survival time of patients with preoperative serum CA-125<35U/ml and preoperative serum CA-125≥35U/ml,type I EC and type II EC,the depth of myometrial invasion less than 1/2 and depth of myometrial invasion greater than or equal to 1/2,pathological grading Ⅱ-Ⅲ and pathological grading Ⅰ,lymph node negative and lymph node positive,cervical invasion negative and cervical invasion positive,lymphovascular space invasion negative and lymphovascular space invasion positive,ascites negative and ascites positive were 137.2 months(95%CI:129.750-148.211)versus 134.9 months(95%CI:115.562-147.352),141.9 months(95%CI:135.560-148.283)versus 83.5 months(95%CI:55.100-111.900),138.7 months(95%CI:131.308-149.141)versus 123.1 months(95%CI:106.188-140≥.627),139.4months(95%CI:132.232-146.642)versus 115.8 months(95%CI:95.548-135.170),114.6months(95%CI:97.105-132.272)versus 143.5 months(95%CI:137.401-149.785),137.8months(95%CI:127.790-147.911)versus 53.7months(95%CI:31.926-75.645),139.1months(95%CI:131.976-146.356)versus 119.3 months(95%CI:99.621-139.119),138.0 months(95%CI : 131.001-145.054)versus 104.5 months(95%CI :75.050-133.975),139.4 months(95%CI : 131.381-147-612)versus 135.7 months(95%CI:117.575-154.008),respectively.In the results of univariate analysis,type II EC,FIGO Stage Ⅲ-Ⅳ,depth of myometrial invasion greater than or equal to 1/2,pathological grading Ⅱ-Ⅲ,LNM positive and LVSI positive were the risk factors that affected the survival prognosis of EC patients(P<0.05).Cox regression analysis results show that type II EC,FIGO StageⅢ-Ⅳ,depth of myometrial invasion greater than or equal to 1/2,pathological gradingⅡ-Ⅲ,LNM positive and LVSI positive were independent risk factors that affected the survival prognosis of EC patients(P<0.05).Instead,EC patients with type I EC,FIGO Stage Ⅰ-Ⅱ,depth of myometrial invasion less than 1/2,pathological grading Ⅰ,LNM negative or LVSI will have good prognosis.Conclusions:1.This study indicate that reoperative serum CA-125≥35U/ml,cervical invasion positive,and LVSI positive were independent factors of PLN metastasis.The rate of PLN metastasis was increased significantly with the increase of the number of independent risk factors.2.This study indicate that preoperative serum CA125 level,pathological grading,lymphovascular space invasion,preoperative MRI,PLN metastasis(including left PLN metastasis and right PLN metastasis)were associated with PALN metastasis in EC patients.PLN,(including left PLN metastasis and right PLN metastasis)were independent risk factors of PALN metastasis.3.This study indicate that type II endometrial carcinoma,FIGO Stage Ⅲ-Ⅳ,depth of myometrial invasion greater than or equal to 1/2,pathological grading Ⅱ-Ⅲ,LNM positive and LVSI positive were the risk factors that affected the survival prognosis of EC patients,and they were also the independent risk factors that affected the survival prognosis of EC patients.EC patients with type I endometrial carcinoma,FIGO StageⅠ-Ⅱ,depth of myometrial invasion less than 1/2,pathological grading Ⅰ,lymph node negative or lymphovascular space invasion will have good prognosis.4.This study assists in evaluating lymph node metastasis status,helps to determine whether EC patients have lymphadenectomy,and contributes to judging the prognosis and guiding postoperative adjuvant therapy to achieve individualized therapy.