术前指标对子宫内膜癌淋巴脉管间隙浸润风险的影响

Effect of preoperative indicators on the risk of lymph-vascular space invasion in endometrial carcinoma

摘要:

目的 研究影响淋巴脉管间隙浸润（lymph-vascular space invasion，LVSI）的子宫内膜癌（endometrial cancer，EC）患者临床病理特征，并确定独立危险因素。方法 回顾性分析2019年1月至2022年8月于遵义医科大学附属医院及第二附属医院住院的196例EC患者临床病理资料。评估的危险因素包括术前癌抗原125（carbohydrate antigen 125，CA125）水平、术前癌抗原199（carbohydrate antigen 199，CA199）水平、病理类型、组织学分级、肿瘤大小、肌层浸润深度、中性粒细胞-淋巴细胞比值、错配修复表达情况、Ki67、P53等。应用卡方检验及logistic回归分析确定EC患者LVSI的危险因素。结果 196例EC患者中，共有23例存在LVSI阳性，阳性率11.7％。多因素分析结果显示术前CAl25≥35 U/mL（OR=3.539，95%CI=1.252~10.008）、肌层浸润深度≥1/2（OR=3.893，95%CI=1.323~11.451）和低分化（组织学分级）（OR=3.206，95%CI=1.030~9.978）是EC患者LVSI的独立危险因素（P<0.05）。结论 术前CAl25≥35 U/mL、肌层浸润深度≥1/2和低分化（组织学分级）是EC患者LVSI的独立危险因素，重视术前预测因子联合评估EC患者的LVSI状态可以帮助术者进一步评估淋巴结受累情况及预后情况，从而更好地选择手术方式，实现个体化、精准化治疗。

Abstract:

Objective To investigate the clinicopathological features of patients with endometrial carcinoma（EC） affecting lymph-vascular space invasion（LVSI）， and to identify independent risk factors.Methods A retrospective analysis was performed for the clinicopathological data of 196 patients with EC who underwent treatment in Affiliated Hospital of Zunyi Medical University and The Second Affiliated Hospital of Zunyi Medical University from January 2019 to August 2022. The risk factors evaluated included preoperative carbohydrate antigen 125（CA125），preoperative carbohydrate antigen 199，pathological type，histological grade，tumor size，depth of myometrial invasion，neutrophil-to-lymphocyte ratio，expression of mismatch repair proteins，Ki67，and P53. The chi-square test and the logistic regression analysis were used to determine the risk factors for LVSI in EC.Results Among the 196 patients with EC，23 were positive for LVSI，with a positive rate of 11.7%. The multivariate analysis showed that preoperative CA125≥35 U/mL[odds ratio（OR）=3.539，95%CI=1.252-10.008，P<0.05]，myometrial invasion depth≥1/2（OR=3.893，95%CI=1.323-11.451，P<0.05），and poor differentiation（OR=3.206， 95%CI=1.030-9.978，P<0.05） were independent risk factors for LVSI in patients with EC.Conclusion Preoperative CA125≥35 U/mL，myeloid invasion depth≥1/2，and poor differentiation（histologic grade） are independent risk factors for LVSI in patients with EC，and the emphasis on preoperative predictive factors combined with the assessment of LVSI status in patients with EC can help surgeons to further evaluate lymph node involvement and prognosis and better select the surgical approach， so as to realize individualized precise treatment.