ENDOMETRİUMLA SINIRLI YA DA MYOMETRİUMUN YARISINA KADAR İNVAZYONU OLAN ENDOMETRİOİD TİP ENDOMETRİAL ADENOKARSİNOM: OPERASYON TİPİNİN SAĞKALIM ÜZERİNE ETKİSİ
Amaç: Endometriumla s›n›rl› ya da myometriumun yar›s›na kadar invazyonu olan endometrioid tip grade 1 endometrial adenokarsinom vakalar›nda lenf nodu örneklemesinin sa¤kal›m oranlar› üzerindeki etkisini araflt›rmak. Materyal ve Metod: 1993-1998 y›llar› aras›nda endometrioid tip grade 1 endometrial adenokarsinom tan›s› ile opere edilen tüm hastalar›n medikal kay›tlar› incelendi. Frozen section patoloji sonucuna göre Total Abdominal Histerektomi (TAH) + Bilateral Salpingo-ooforektomi (BSO) + Omental Biopsi (OB) + Peritoneal Sitolojik Örnekleme (PCS) (Grup A) ya da TAH + BSO + OB + PCS + Lenf Nodu Örneklemesi (LNS) (Grup B) yap›lan endometriumla s›n›rl› ya da myometriumun yar›s›na kadar invazyonu olan endometrioid tip grade 1 endometrial adenokarsinom olgusu çal›fl- maya dahil edildi. Hastalar›n yafl›, menopozal durumlar›, tümör karakteristikleri ve rekürrensler not edildi. Bulgular: Seksenbir olgu çal›flmaya dahil edildi. Grup A’da 62 hasta, Grup B’de 19 hasta vard›. Her iki grup ortalama yafl, gravida, vücut kütle indeksi (BMI) ve menopozal durum aç›s›ndan benzerdi. Her grupta bir rekürrens meydana geldi. Tümör Grup A’da jejunumda, Grup B’de vajinal güdükte nüksetti. Rekürrens oranlar› istatistiksel olarak farkl› de¤ildi. Grup A’da hiç ölüm olmazken, Grup B’de 5 ölüm oldu ancak bunlar›n hiçbiri kansere ba¤l› ölümler de¤ildi. Befl- ve 10-y›ll›k toplam sa¤kal›m oranlar› Grup A’da Grup B’ye göre anlaml› olarak yüksekti (p<0.05) ancak 5- ve 10- y›ll›k hastal›ks›z sa¤kal›m oranlar› benzerdi. Sonuç: Histerektomi + Lenf nodu örneklemesi yap›lan hastalarla sadece histerektomi yap›lan hastalar›n toplam sa¤kal›m oran› ayn› idi. Endometrial adenokarsinomda lenf nodu örneklemesi evrelendirmenin do¤ru yap›labilmesini sa¤lad›¤› için de¤erlidir ancak frozen section patoloji sonucuna göre endometriumla s›n›rl› ya da myometriumun yar›s›na kadar invazyonu olan endometrioid tip grade 1 endometrial adenokarsinom olgular›nda toplam sa¤kal›m ve rekürrens oranlar›na etkisi yok gibi gözükmektedir
Objective: To determine the impact of lymph node sampling on survival rates in endometrioid type grade 1 endometrial adenocarcinoma confined to the endometrium or with less than inner half myometrial invasion. Materials and Method: Medical reports of all patients treated for endometrioid type grade 1 endometrial adenocarcinoma between 1993-1998 at the Department of Gynecologic Oncology were reviewed. Patients who had endometrioid type endometrial adenocarcinoma confined to the endometrium or with less than inner half myometrial invasion as determined by frozen section and underwent Total Abdominal Hysterectomy (TAH) + Bilateral Salpingooophorectomy (BSO) + Omental Biopsy (OB) + Peritoneal Cytologic Sampling (PCS) (Group A) or TAH + BSO + Lymph Node Sampling (LNS) + OB + PCS (Group B) were included in the study. Patients’ age, menopausal status, tumor characteristics and recurrences were noted. Results: Eighty-one patients were included in the study. There were 62 patients in Group A and 19 patients in Group B. Both groups were similar in terms of mean age, gravida, BMI and menopausal status. There was one recurrence in each group. The tumor recurred in jejunum in Group A and in the vaginal stump in Group B. Recurrence rates were not statistically different. None of the patients died in Group A, while 5 patients died in Group B, although this difference was statistically significant, the five patients in Group B had died disease-free. Five- and 10-year overall survival rates were significantly higher in Group A when compared with Group B (p<0.05) but 5- and 10-year diease-free survival rates were similar in both groups. Conclusion: The survival rate for patients who underwent hysterectomy + lymph node sampling was similar to that of patients who underwent only hysterectomy. Lymph node sampling in endometrial adenocarcinoma is worthwhile as it allows staging to be performed properly, nevertheless it seems to have no effect on overall and disease-free survival rates and recurrence rates when the disease is grade 1 and confined to the endometrium or there is less than inner myometrial invasion as determined by frozen section.
