Endometrial kanserde lenfatik nükslerde prognozu etkileyen faktörler

Abstract

Amaç: Bu çalışma, cerrahi sonrası izole pelvik ve/veya periaortik lenf nodu rekürrensi (LNR) gelişen endometrioid tip endometrial kanser (ETEK) hastalarında prognozu ve onkolojik sonuçları etkileyen faktörleri değerlendirmeyi amaçlamıştır. Yöntemler: Hastanemizde 2017-2024 yılları arasında ETEK nedeniyle histerektomi ve salpingooferektomi yapılan 24 hasta üzerinde retrospektif bir analiz gerçekleştirildi. Bu hastalarda lenfatik rekürrens paternleri şu şekilde kategorize edildi: 6 hastada (%25,0) izole pelvik lenf nodu metastazı (PLNM), 7 hastada (%29,2) izole periaortik lenf nodu metastazı (PALNM) ve 11 hastada (%45,8) hem PLNM hem de PALNM. Rekürrens sonrası sağkalım sonuçları değerlendirildi ve rekürrens sonrası sağkalımı etkileyen faktörleri belirlemek için lojistik regresyon analizi uygulandı. Bulgular: Rekürrens sonrası sağkalımı ≥2 yıl olan 8 hasta (%33,3) tespit edildi. Tek değişkenli analizde grade 3 tümörler, derin miyometriyal invazyon, hastalıksız sağkalım süresinin (DFS) ≥18 ay olması ve rekürrens cerrahi rezeksiyonu prognozu etkileyen önemli faktörler olarak belirlendi. Ancak çok değişkenli analizde bağımsız prognostik faktörler bulunamadı. Özellikle, grade 3 tümörler ve derin miyometriyal invazyon daha kötü sağkalım sonuçları ile ilişkilendirilirken, uzun DFS süresi (≥18 ay) ve rekürrens cerrahisi prognoz üzerinde olumlu bir etkiye sahipti. Sonuç: ETEK ve izole lenfatik rekürrensi olan hastalarda, grade 3 tümörler ve derin miyometriyal invazyon sağkalım sonuçlarını olumsuz etkileyebilir. Uzun DFS süresi (≥18 ay) ve rekürrens cerrahisi prognozla ilişkili önemli faktörlerdir. Bu bulgular, bu hasta popülasyonunda sonuçları optimize etmek için bireyselleştirilmiş yönetim stratejilerinin önemini vurgulamaktadır.

Keywords

• endometrial kanser
• lenf nodu
• nüks
• cerrahi

Factors affecting the prognosis of lymphatic recurrences in endometrial cancer

Abstract

Objective: This study aimed to evaluate factors influencing prognosis and oncological outcomes in patients with endometrioid-type endometrial cancer (EEC) who developed isolated pelvic and/or periaortic lymph node recurrence (LNR) after surgery. Methods: A retrospective analysis was conducted on 24 patients who underwent hysterectomy and salpingo-oophorectomy for EEC in our hospital between 2017 and 2024. Among these patients, lymphatic recurrence patterns were categorized as follows: isolated pelvic lymph node metastasis (PLNM) in 6 patients (25.0%), isolated periaortic lymph node metastasis (PALNM) in 7 patients (29.2%), and both PLNM and PALNM in 11 patients (45.8%). Survival outcomes after recurrence were evaluated, with logistic regression analysis applied to identify factors affecting post-recurrence survival. Results: Post-recurrence survival ≥2 years was observed in 8 patients (33.3%). Univariate analysis identified grade 3 tumors, deep myometrial invasion, disease-free survival (DFS) ≥18 months, and surgical resection of recurrence as significant factors influencing prognosis. However, multivariate analysis did not reveal any independent prognostic factors. Notably, grade 3 tumors and deep myometrial invasion were associated with poorer survival outcomes, while longer DFS (≥18 months) and surgical resection of recurrence had a favorable impact on prognosis. Conclusion: In patients with EEC and isolated lymphatic recurrence, grade 3 tumors and deep myometrial invasion appear to negatively affect survival outcomes. A longer DFS (≥18 months) and surgical resection of recurrence are important factors associated with improved prognosis. These findings highlight the need for individualized management strategies to optimize outcomes in this patient population.

Keywords

• recurrence
• surgery
• endometrial cancer
• lymph node.

References

1. 1.Siegel RL, Miller KD, Fuchs HE, et al. Cancerstatistics, 2022. CA Cancer J Clin. 2022;72:7-33.
2. 2.Kim NR, So KA, Kim TJ, et al. Role of systematiclymphadenectomy in patients with intermediate tohigh-risk early-stage endometrial cancer. J GynecolOncol. 2023;34:e23
3. 3.Rechichi G, Galimberti S, Signorelli M, et al.Myometrial invasion in endometrial cancer:diagnostic performance of diffusion-weighted MRimaging at 1.5-T. Eur Radiol. 2010;20:754-62.
4. 4.Mariani A, Dowdy SC, Podratz KC. New surgicalstaging of endometrial cancer: 20 years later. Int JGynaecol Obstet. 2009;105:110-1
5. 5.Pelikan HM, Trum JW, Bakers FC, et al. Diagnosticaccuracy of preoperative tests for lymph node statusin endometrial cancer: a systematic review. CancerImaging. 2013;13:314-22.
6. 6.Shepherd JH. Revised FIGO staging forgynaecological cancer. Br J Obstet Gynaecol.1989;96:889-92.
7. 7.Lampe B, Kurzl R, Hantschmann P. Prognosticfactors that predict pelvic lymph node metastasis from endometrial carcinoma. Cancer. 1994;74:2502-8.
8. 8.Widschwendter P, Bauer E, De Gregorio N et al.Influence of Prognostic Factors on Lymph NodeInvolvement in Endometrial Cancer: A Single-CenterExperience. Int J Gynecol Cancer. 2018;28:1145-52.

9. 9.Karube Y, Fujimoto T, Takahashi O et al.Histopathological prognostic factors predictingpara-aortic lymph node metastasis in patients withendometrioid uterine cancer. Gynecol Oncol.2010;118:151-4.
10. 10.Nomura H, Aoki D, Suzuki N et al. Analysis ofclinicopathologic factors predicting para-aorticlymph node metastasis in endometrial cancer. Int J Gynecol Cancer. 2006;16:799-804.
11. 11.Ho JC, Allen PK, Jhingran A et al. Management ofnodal recurrences of endometrial cancer with IMRT.Gynecol Oncol. 2015;139:40-6.
12. 12.Kim HS, Suh DH, Kim MK, et al. Systematiclymphadenectomy for survival in patients withendometrial cancer: a meta-analysis. Jpn J ClinOncol. 2012;42:405-12.
13. 13.Erdoğan M, Güzelöz Z, Demir G, et al.Radiotherapy in Adjuvant Therapy in High-intermediate Risk and High Risk EndometrialCancer: A Review Article. J Tepecik Educ Res Hosp.2023;33(1):7-11.