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Evre IIIC Endometrium Kanserinde Paraaortik Lenf Nodu Metastazı Varlığına Göre Klinik, Cerrahi ve Patolojik Faktörlerin Dağılımı

Year 2023, Volume: 20 Issue: 2, 1748 - 1752, 03.07.2023
https://doi.org/10.38136/jgon.1186328

Abstract

Özet
Amaç: Bu çalışmada Evre IIIC1 ve evre IIIC2 endometrium kanserinde, hasta grupları arasında klinik, cerrahi ve patolojik risk faktörlerinin dağılımını incelemek ve farklılığı tanımlamak amaçlanmıştır.
Gereçler ve Yöntem: Kliniğimizde FIGO 2009 kriterlerine göre evre IIIC1-2 endometrium kanseri tanısı alan 115 hasta çalışmaya dâhil edildi. Hastaların demografik, klinik, cerrahi ve patolojik özellikleri hasta dosyalarından ve patoloji raporlarından retrospektif olarak elde edildi.
Bulgular: Hastaların 39’unda (%33.9) sadece pelvik lenf nodu metastazı, 14’ünde (%12.2) sadece paraaortik lenf nodu metastazı, 62’sinde (%53.9) ise hem pelvik hem paraaortik lenf nodu metastazı mevcuttu. Otuz dokuz (%33.9) hasta FIGO IIIC1, 76 (%66.1) hasta FIGO IIIC2 evredeydi. Evre IIIC2 hasta grubunda evre IIIC1’e göre derin myometrial invazyon ve malign peritoneal sitoloji istatistiksel olarak anlamlı yüksekti. Buna karşın yaş, tümör boyutu, çıkarılan lenf nodu sayısı, preoperatif CA 125 değeri, FIGO grade derecesi, lenfovasküler alan invazyonu, servikal tutulum durumu ve adneksal metastaz durumu ile hastalığın paraaortik bölgeye yayılıp yayılmaması arasında anlamlı farklılık gözlenmedi.
Sonuç: Evre IIIC endometrium kanserinde paraaortik lenf nodu metastazı varlığında derin miyometrial invazyon ve malign peritoneal sitoloji görülme olasılığı artmaktadır.

References

  • 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021;71(3):209-49.
  • 2. Mittal KR, Schwartz PE, Barwick KW. Architectural (FIGO) grading, nuclear grading, and other prognostic indicators in stage I endometrial adenocarcinoma with identification of high‐risk and low‐risk groups. Cancer. 1988;61(3):538-45.
  • 3. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. International Journal of Gynecology & Obstetrics. 2018;143:37-50.
  • 4. Kitchener H, Swart A, Qian Q, Amos C, Parmar M. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England). 2008;373(9658):125-36.
  • 5. Tock S, Jadoul P, Squifflet J-L, Marbaix E, Baurain J-F, Luyckx M. Fertility sparing treatment in patients with early stage endometrial cancer, using a combination of surgery and GnRH agonist: a monocentric retrospective study and review of the literature. Frontiers in medicine. 2018;5:240.
  • 6. Ueda SM, Kapp DS, Cheung MK, Shin JY, Osann K, Husain A, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. American journal of obstetrics and gynecology. 2008;198(2):218. e1-. e6.
  • 7. Van Wijk F, Huikeshoven F, Abdulkadir L, Ewing P, Burger C. Stage III and IV endometrial cancer: a 20-year review of patients. International Journal of Gynecologic Cancer. 2006;16(4).
  • 8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer. 1987;60(S8):2035-41.
  • 9. Turan T, Hizli D, Sarici S, Boran N, Gundogdu B, Karadag B, et al. Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011;158(2):274-9.
  • 10. Chi D, Barakat R, Palayekar M, Levine D, Sonoda Y, Alektiar K, et al. The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology. International Journal of Gynecologic Cancer. 2008;18(2).,
  • 11. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. The Lancet. 2010;375(9721):1165-72.
  • 12. Fujimoto T, Nanjyo H, Nakamura A, Yokoyama Y, Takano T, Shoji T, et al. Para-aortic lymphadenectomy may improve disease-related survival in patients with multipositive pelvic lymph node stage IIIc endometrial cancer. Gynecologic oncology. 2007;107(2):253-9.
  • 13. Şahin H, SARI ME, YALÇIN İ, Özkan NT, Korkmaz V, Güngör T, et al. Evre 3C Endometrioid Tip Endometrium Kanserlerinin Analizi: Evre IIIC1 ve Evre IIIC2 Arasında Sağ Kalım Farkı Var mı? Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2017;14(4):155-9.
  • 14. Garg G, Morris RT, Solomon L, Toy EP, Kruger M, Clary K, et al. Evaluating the significance of location of lymph node metastasis and extranodal disease in women with stage IIIC endometrial cancer. Gynecologic oncology. 2011;123(2):208-13.
  • 15. Kikuchi A, Yanase T, Sasagawa M, Honma S. The role of para-aortic lymphadenectomy in stage IIIC endometrial cancer: a single-institute study. Journal of Obstetrics and Gynaecology. 2017;37(4):510-3.
  • 16. Dong Y, Wang Z, Wang J. Positive peritoneal cytology is an independent risk factor in endometrial cancer. Journal of Obstetrics and Gynaecology Research. 2020;46(9):1842-50.
  • 17. Garg G, Gao F, Wright JD, Hagemann AR, Mutch DG, Powell MA. Positive peritoneal cytology is an independent risk-factor in early stage endometrial cancer. Gynecologic oncology. 2013;128(1):77-82.

Distribution of Clinical, Surgical, and Pathological Factors in Stage IIIC Endometrial Cancer Patients with Paraaortic Lymph Node Metastasis

Year 2023, Volume: 20 Issue: 2, 1748 - 1752, 03.07.2023
https://doi.org/10.38136/jgon.1186328

Abstract

Abstract
Aim: To analyze the distribution of clinical, surgical, and pathological risk variables among patient groups in stage IIIC1 and stage IIIC2 endometrium cancer, and to identify the differences.
Materials and Method: The study comprised 115 endometrial cancer patients identified as stage IIIC1-2 in our clinic, according to FIGO 2009 criteria. Patients' demographic, clinical, surgical, and pathological features were retrospectively extracted from patient files and pathology reports.
Results: Thirty-nine (33.9%) patients had only pelvic lymph node metastases, 14 (12.2%) patients had only paraaortic lymph node metastases, and 62 (53.9%) patients had both pelvic and paraaortic lymph node metastases. The stages of 39 (33.9%) patients were FIGO IIIC1 and 76 (66.1%) were FIGO IIIC2. Deep myometrial invasion and malignant peritoneal cytology were statistically higher in stage IIIC2 patients than in stage IIIC1 patients. However, age, tumor size, number of lymph nodes excised, preoperative CA 125 value, FIGO grade, lymphovascular space invasion, cervical involvement, and adnexal metastases did not found to be associated with the disease dissemination to the paraaortic area.
Conclusion: Deep myometrial invasion and malignant peritoneal cytology is higher in stage IIIC endometrial cancer patients with paraaortic lymph node metastases.

References

  • 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021;71(3):209-49.
  • 2. Mittal KR, Schwartz PE, Barwick KW. Architectural (FIGO) grading, nuclear grading, and other prognostic indicators in stage I endometrial adenocarcinoma with identification of high‐risk and low‐risk groups. Cancer. 1988;61(3):538-45.
  • 3. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. International Journal of Gynecology & Obstetrics. 2018;143:37-50.
  • 4. Kitchener H, Swart A, Qian Q, Amos C, Parmar M. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England). 2008;373(9658):125-36.
  • 5. Tock S, Jadoul P, Squifflet J-L, Marbaix E, Baurain J-F, Luyckx M. Fertility sparing treatment in patients with early stage endometrial cancer, using a combination of surgery and GnRH agonist: a monocentric retrospective study and review of the literature. Frontiers in medicine. 2018;5:240.
  • 6. Ueda SM, Kapp DS, Cheung MK, Shin JY, Osann K, Husain A, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. American journal of obstetrics and gynecology. 2008;198(2):218. e1-. e6.
  • 7. Van Wijk F, Huikeshoven F, Abdulkadir L, Ewing P, Burger C. Stage III and IV endometrial cancer: a 20-year review of patients. International Journal of Gynecologic Cancer. 2006;16(4).
  • 8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer. 1987;60(S8):2035-41.
  • 9. Turan T, Hizli D, Sarici S, Boran N, Gundogdu B, Karadag B, et al. Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2011;158(2):274-9.
  • 10. Chi D, Barakat R, Palayekar M, Levine D, Sonoda Y, Alektiar K, et al. The incidence of pelvic lymph node metastasis by FIGO staging for patients with adequately surgically staged endometrial adenocarcinoma of endometrioid histology. International Journal of Gynecologic Cancer. 2008;18(2).,
  • 11. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. The Lancet. 2010;375(9721):1165-72.
  • 12. Fujimoto T, Nanjyo H, Nakamura A, Yokoyama Y, Takano T, Shoji T, et al. Para-aortic lymphadenectomy may improve disease-related survival in patients with multipositive pelvic lymph node stage IIIc endometrial cancer. Gynecologic oncology. 2007;107(2):253-9.
  • 13. Şahin H, SARI ME, YALÇIN İ, Özkan NT, Korkmaz V, Güngör T, et al. Evre 3C Endometrioid Tip Endometrium Kanserlerinin Analizi: Evre IIIC1 ve Evre IIIC2 Arasında Sağ Kalım Farkı Var mı? Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2017;14(4):155-9.
  • 14. Garg G, Morris RT, Solomon L, Toy EP, Kruger M, Clary K, et al. Evaluating the significance of location of lymph node metastasis and extranodal disease in women with stage IIIC endometrial cancer. Gynecologic oncology. 2011;123(2):208-13.
  • 15. Kikuchi A, Yanase T, Sasagawa M, Honma S. The role of para-aortic lymphadenectomy in stage IIIC endometrial cancer: a single-institute study. Journal of Obstetrics and Gynaecology. 2017;37(4):510-3.
  • 16. Dong Y, Wang Z, Wang J. Positive peritoneal cytology is an independent risk factor in endometrial cancer. Journal of Obstetrics and Gynaecology Research. 2020;46(9):1842-50.
  • 17. Garg G, Gao F, Wright JD, Hagemann AR, Mutch DG, Powell MA. Positive peritoneal cytology is an independent risk-factor in early stage endometrial cancer. Gynecologic oncology. 2013;128(1):77-82.
There are 17 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Okan Aytekin 0000-0002-6430-4607

Yeşim Özkaya Uçar 0000-0002-1957-4202

Burak Ersak 0000-0003-3301-062X

Fatih Çelik 0000-0002-9523-180X

Günsu Kimyon Cömert 0000-0003-0178-4196

Bülent Özdal 0000-0001-9829-688X

Publication Date July 3, 2023
Submission Date October 9, 2022
Acceptance Date December 11, 2022
Published in Issue Year 2023 Volume: 20 Issue: 2

Cite

Vancouver Aytekin O, Özkaya Uçar Y, Ersak B, Çelik F, Kimyon Cömert G, Özdal B. Evre IIIC Endometrium Kanserinde Paraaortik Lenf Nodu Metastazı Varlığına Göre Klinik, Cerrahi ve Patolojik Faktörlerin Dağılımı. JGON. 2023;20(2):1748-52.