Funda ATALAY, Fisun ARDIÇ, Kadir ÇETİNKAYA

Tümör Boyutunun Endometrium Kanserinde Lenf Nodu Metastazına Etkisi

Amaç: Endometrium kanseri EK ’nde sağ kalım açısından lenf nodu metastazı LNM ’nın önemli bir etkisi vardır ve LNM %5-15 civarında izlenir. Ameliyat öncesi dönemde ya da ameliyat sırasında LNM olan hastalar tespit edilebilirse, geri kalan diğer hastalar lenf nodu diseksiyonu LND ’na maruz kalmayabilir. Tümör boyutu TB lenfatik yayılımda risk faktörlerinden olup, bu çalışmada ameliyat sırasında LNM’nı tahmin başarısındaki yerini değerlendirmek amaçlanmıştır.Gereç ve Yöntemler: Ankara Onkoloji Eğitim ve Araştırma Hastanesi’nde Temmuz 2014 ile Mart 2016 arasında EK nedeniyle evreleme cerrahisi ve ameliyat sırasında frozen uygulanan 40 hastanın dosya bilgileri geriye dönük olarak incelendi. Tüm hastalarda LNM’nı etkileyen histolojik tip, greyd G , miyometrial invazyon derinliği MİD , servikal stromal invazyon SSİ ve TB analiz edildi. Hastalar LNM riski açısından dört gruba ayrıldı ve TB >2 cm, >3 cm, >4 cm ve >5 cm olarak belirlendi.Bulgular: Hastaların ortalama yaşı 59.09 ± 9.14 yıl 38-79, medyan 59 idi. Toplam 40 cerrahi olarak evrelenmiş EK’li hastadan üçünde %7,5 LNM izlendi. Uluslar arası Jinekoloji ve Obstetrik Federasyonu FİGO 2009 evreleme sistemine göre evreler IA, IB, II, IIIA, IIIC1 ve IIIC2 sırası ile %75,0 n=30 , %7,5 n=3 , %5,0 n=2 , %5,0 n=2 , %5,0 n=2 , %2,5 n=1 olarak izlendi. Hastaların TB >2 cm, >3 cm, >4 cm ve >5 cm şeklinde sırasıyla 28 %70,0 , 21 %52,5 , 11 %27,5 ve 7 %17,5 tespit edildi. Tümör boyutu ≤2 cm n=12, %30,0 olan tüm hastalar evre IA idi ve LNM izlenen tüm hastalarda TB >3 cm olarak tespit edildi.Sonuç: Bu çalışmada TB ≤3 cm olan hiç bir hastada % 47,5 LNM izlenmedi. Ameliyat sırasında LNM tahmini ve LND için karar verme aşamasında TB önemli bir parametre olabilir.

Anahtar Kelimeler:

Endometrium kanseri, tümör boyutu, lenf nodu metastazı

The Impact Of Tumor Size On Predicting Lymph Node Metastasis In Endometrial Carcinoma

Aim: Lymph node metastasis LNM has an important influence on survival in endometrial carcinoma EC and LNM occurs about 5-15%. If the LNM group of patients predicted before or during surgery, then the remaining patients could avoid exposure to lymph node dissection LND . Tumor size TS is one of risk factors associated with lymph node spread and we aimed to evaluate the impact of TS on predicting LNM during surgery.Material and Methods: Patient chart information of 40 patients who had been treated by surgical staging and applied frozen section peroperatively at Ankara Oncology Education and Research Hospital due to EC between July 2014 and March 2016 were retrospectively reviewed. Factors that were likely to have an effect on LNM in all patients, such as histological type, grade G , myometrial invasion deepness MID , cervical stromal invasion CSI and TS were analyzed. Patients were separated into four groups and TS was studied as >2 cm, >3 cm, >4 cm and >5 cm related to LNM defined as risk groups.Results: The mean age of the patients was 59.09 ± 9.14 years range 38-79, median 59 . Three patients had LNM 7.5% out of 40 surgically staged EC patients. The stages were seen as 75.0% n=30 , 7.5% n=3 , 5.0% n=2 , 5.0% n=2 , 5.0% n=2 , 2.5% n=1 according to the 2009 International Federation of Gynecology and Obstetrics FIGO stages IA, IB, II, IIIA, IIIC1 and IIIC2. There were 28 70.0% , 21 52.5% , 11 27.5% and 7 17.5% patients, as TS >2 cm, >3 cm, >4 cm and >5 cm, respectively. All patients with ≤2 cm TS n=12, 30.0% were stage IA and all patients with LNM n=3, 7.5% were >3 cm TS.Conclusion: In this study, in EC patients with ≤3 cm TS 47.5% showed no LNM. Tumor size might have a value in predicting LNM and deciding LND in EC during surgery.

Keywords:

Endometrial cancer, tumor size, lymph node metastasis,

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