低危子宫内膜癌淋巴结转移相关因素分析

朱梦秋; 易倩琳; 蒋鹏

doi:10.16016/j.1000-5404.202102114

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低危子宫内膜癌淋巴结转移相关因素分析

临床医学 | 更新时间：2026-01-09

- 低危子宫内膜癌淋巴结转移相关因素分析
- Related factors for lymph node metastasis in low-risk endometrial cancer: analysis of 409 cases
- 第三军医大学学报 2021年43卷第16期页码：1581-1586
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院妇科
- 作者简介：
  
  [蒋鹏，E-mail: jiangpeng1106@sina.comJIANG Peng, E-mail: jiangpeng1106@sina.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202102114
  中图分类号： R73-37;R730.23;R737.33
- 收稿：2021-02-22，
  
  修回：2021-06-04，
  
  纸质出版：2021-08-30
- 稿件说明：
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朱梦秋, 易倩琳, 蒋鹏. 低危子宫内膜癌淋巴结转移相关因素分析[J]. 第三军医大学学报, 2021,43(16):1581-1586.

Mengqiu ZHU, Qianlin YI, Peng JIANG. Related factors for lymph node metastasis in low-risk endometrial cancer: analysis of 409 cases[J]. Journal of Third Military Medical University, 2021, 43(16): 1581-1586.
朱梦秋, 易倩琳, 蒋鹏. 低危子宫内膜癌淋巴结转移相关因素分析[J]. 第三军医大学学报, 2021,43(16):1581-1586. DOI： 10.16016/j.1000-5404.202102114.

Mengqiu ZHU, Qianlin YI, Peng JIANG. Related factors for lymph node metastasis in low-risk endometrial cancer: analysis of 409 cases[J]. Journal of Third Military Medical University, 2021, 43(16): 1581-1586. DOI： 10.16016/j.1000-5404.202102114.

摘要

目的

探讨低危子宫内膜癌淋巴结转移的相关因素，确定免疫组化指标雌激素受体(estrogen receptor，ER)和孕激素受体(progesterone receptor，PR)预测淋巴结转移的最佳阳性阈值，寻找预测淋巴结转移的最佳预测因子组合，为临床诊疗提供辅助参考指标。

方法

通过纳入及排除标准纳入409例于2013年10月至2020年6月在我科接受了标准手术治疗的低危子宫内膜癌患者的临床病理资料，患者中位年龄51(25~77)岁，体质指数为24.56 (16.35~45.72) kg/m

。使用单因素及多因素Logistic回归分析各临床病理因素与淋巴结转移的相关性，使用受试者工作特征曲线(receiver operating characteristic curve，ROC曲线)及约登指数确定用于评估淋巴结转移的雌孕激素受体的最佳阳性阈值，在此基础上比较单一预测因子与联合预测因子之间的预测价值从而找到预测淋巴结转移的最佳预测因子组合。

结果

多因素分析发现淋巴脉管间隙侵犯(lymphatic vessel space invasion，LVSI)(

=0.000)、癌抗原125(cancer antigen 125

Ca125；

=0.027)、ER(

=0.004)、PR(

=0.045)及P53(

=0.003)是淋巴结转移的相关因素。ROC曲线及约登指数显示预测淋巴结转移的ER及PR的最佳阳性阈值分别为38%和43%，在此基础上，以ER、Ca125及P53构建Logistic回归模型预测淋巴结转移的曲线下面积(area under the curve，AUC)为0.837，显著优于其他单一预测因子(

＜0.05)。

结论

以大约40%的阳性百分比作为雌孕激素受体的阳性阈值能较为准确地预测低危子宫内膜癌的淋巴结转移，在此基础上，可以以ER联合Ca125及P53为最佳预测因子组合构建Logistics回归模型对低危子宫内膜癌淋巴结转移进行预测。

Abstract

Objective

To investigate the factors related to lymph node metastasis in low-risk endometrial cancer

determine the best positive thresholds of immunohistochemical makers estrogen receptor (ER) and progesterone receptor (PR) in prediction of metastasis

and explore the optional combination of predictors in order to provide auxiliary reference indicators for clinical diagnosis and treatment.

Methods

According to our inclusion and exclusion criteria

the clinicopathological data of 409 patients with low-risk endometrial cancer who underwent standard surgical treatment in our department from October 2013 to June 2020 were collected and analyzed in this study. Their median age was 51 (25~77) years

and median body mass index was 24.56 (16.35~45.72) kg/m

. Univariate and multivariate Logistic regression analyses were used to study the correlations between each clinicopathological factor and lymph node metastasis

and receiver operating characteristic (ROC) curve and Youden index were used to determine the estrogen and progesterone to assess lymph node metastasis. Based on this

the predictive value between the single predictor and the combined predictors was compared to find the best combination of predictors for predicting lymph node metastasis.

Results

Multivariate analysis found that lymphovascular space invasion (LVSI

=0.000)

cancer antigen 125 (Ca125

=0.027)

estrogen receptor (ER

=0.004)

progesterone receptor (PR

=0.045) and P53 (

=0.003) were related factors for lymph node metastasis. ROC curve and Youden index showed that the best positive thresholds for predicting lymph node metastasis of ER and PR were 38% and 43%

respectively. On the bases

the area under the curve (AUC) of a Logistics regression model constructed with ER

Ca125 and P53 was 0.837 in the prediction of lymph node metastasis

which was significantly better than other single predictors (

0.05).

Conclusion

Using a positive percentage of about 40% as the positive threshold of ER and PR can more accurately predict the lymph node metastasis of low-risk endometrial cancer. ER combined with Ca125 and P53 can be the best predictor to construct a logistic regression model to predict lymph node metastasis in low-risk endometrial cancer.

关键词

Keywords

references

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KÖBEL M, RONNETT B M, SINGH N, et al . Interpretation of P53 immunohistochemistry in endometrial carcinomas: toward increased reproducibility[J ] . Int J Gynecol Pathol, 2019, 38(Suppl 1): S123-S131. DOI: 10.1097/pgp.0000000000000488.

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