Erken evre endometrioid tip endometrial kanserli olgularda alt uterin segment tutulumunun anjiolenfatik invazyon, sağkalım ve evreleme üzerine etkilerinin incelenmesi
Predictability of lower uterine segment to angiolymphatic invasion, survival and LYMPH node involvement for early stage endometrioid endometrial cancer
Yazar: YAĞMUR SOYKAN
Danışman: PROF. DR. MEHMET ANIL ONAN
Gazi Üniversitesi / Tıp Fakültesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2017
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology
Dizin: Endometrial neoplazmlar = Endometrial neoplasms ; Endometriyum = Endometrium ; Histerektomi = Hysterectomy ; Lenf nodları = Lymph nodes ; Neoplazmlar = Neoplasms ; Overektomi = Ovariectomy ; Retrospektif çalışmalar = Retrospective studies ; Uterin servikal neoplazmlar = Uterine cervical neoplasms ; Uterus neoplazmları = Uterine neoplasms

Özet:
Amaç: Erken evre endometrioid tip endometrium kanserli olgularda uterus alt segment tutulumunun anjiyolenfatik invazyon, sağkalım ve lenf nodu tutulumu açısından prediktif değer olup olmadığının saptanması.
Materyal ve Metod: ÇalıĢma Gazi Üniversitesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde 01 Ocak 2009 ile 15 Nisan 2017 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi Jinekolojik Onkoloji Kliniğinde opere edilmiş (total abdominal histerektomi+bilateral salpingooferektomi±lenf nodu diseksiyonu) endometrioid tip endometrium kanserli evre 1a ve 1b olan 98 hasta ile retrospektif klinik çalıĢma formatında gerçekleĢtirildi.
Endometrium kanseri nedeniyle opere olan (total abdominal histerektomi ve bilateral salpingo-ooferektomi (TAH+BSO) , bilateral pelvik lenf nodu disseksiyonu ± paraaortik lenf nodu disseksiyonu) Erken Evre Endometrioid Tip Endometrium Kanserli olgularda uterus alt segment tutulumunun anjiyolenfatik invazyon, sağkalım ve evreleme üzerine etkileri açısından prediktif değere sahip olup olmadıklarına bakıldı.
Bulgular: ÇalıĢmaya dahil edilen 98 hastanın 17(%17,3)‟si Evre 1a iken, 65 (%66,3)‟i Evre 1b, 7(%7,1)‟si Evre 3c1, 8(%8,2)‟i Evre 3c2 idi. ÇalıĢmaya dahil edilen 98 hastanın 30(%30,6)‟unda sadece pelvik lenf nodu diseksiyonu, 59(%60,2)‟unda pelvik + paraaortik lenf nodu diseksiyonu yapılırken, sadece paraaortik lenf nodu diseksiyonu yapılan hasta yoktur. 76(%83,5) hastada lenf nodu metastazı saptanmazken, 7(%7,6) hastada sadece pelvik lenf nodu metastazı, 5(%5,4) hastada pelvik + paraaortik lenf nodu metastazı saptanmıĢtır. ÇalıĢmaya dahil edilen 98 hastanın 42(%42,9)‟sinde myometrial invazyon derinliği ½‟den az, 56(%57,1)‟sında ½‟den fazla olarak saptanırken; myometrial invazyon olmayan hasta yoktu. Myometrial invazyon derinliği ½‟den fazla olan 56(%57,1) hastanın 25‟inde alt uterin segment tutulumu mevcuttu, myometrial invazyon derinliği ½‟den az olan 42(%42,9) hastada ise alt uterin segment tutulumu yoktu ve bu istatistiksel olarak anlamlı bulundu (p=0,030). ÇalıĢmaya dahil edilen 98 hastanın 43(%43,8)‟ünde tümör çapı 4 cm‟den küçük, 55(%56,1)‟inde tümör
çapı 4 cm‟den büyük olarak saptanmıĢtır. Tümör çapı 4 cm‟den büyük 55(%56,1) hastanın 38‟inde alt uterin segment tutulumu mevcuttu, tümör çapı 4 cm‟den küçük 43(%43,8) hastada ise alt uterin segment tutulumu yoktu ve bu istatistiksel olarak anlamlı bulundu (p=0,001).
Ayrıca diğer prognostik faktörlerden olan; lenfovasküler alan invazyonu (p=0,852), tümör grade (p=0,392) ve yaĢ (p=0,543) ın alt uterin segment tutulumu ile iliĢkisi olmadığı izlenmiĢtir.
Sonuç: Endometrium kanseri nedeniyle lenf nodu diseksiyonu içeren tümör cerrahisi operasyonu olan hastaların patoloji sonuçları takiplerinde alt uterin segment tutulumu olan hastalarda myometrial invazyon derinliği (>1/2) istatistiksel olarak anlamlı bulunurken, tümör çapı büyüklüğü (>4cm) ve pelvik lenf nodu tutulumu da istatistiksel olarak anlamlı bulunmuĢtur. Ayrıca alt uterin segment tutulumu diğer prognostik faktörlerden LVAI, tümör grade ve yaŞ için belirleyici olarak izlenmedi.

Abstract:
Aim: This study aims to determine the predictability of lower uterine segment to angiolymphatic invasion, survival and lymph node involvement for early stage endometrioid endometrial cancer.
Materials and Methods: The study was performed retrospectively in Gazi University Hospital Obstetrics and Gynecology Clinic including 98 patients who were operated at Gazi University Medical Faculty Gynecological Oncology Clinic from january 2009 to april 2017 (total abdominal hysterectomy + bilateral salpingooferectomy ± lymph node dissection) and had diagnosed stage of 1a and stage 1b endometrioid type endometrial cancer.
The purpose of this study to evalute the predictive value of lower segment involvement to survival, lymph node and angiolymphatic invasion in the cases which were opereted (total abdominal hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection and paraaortic lymph node dissection) for early stage (stage 1a and 1b) endometrioid type endometrial cancer.
Results: The study includes 98 patients with endometrioid type endometrial cancer. In the study 17(17.3%) patients were stage 1a, 65(66.3%) patients were stage 1b, 7(7.1%) patients were stage 3c1 and 8(8.2%) patients were stage 3c2. In the study we performed an operation to 30 patients (30.6%) containing only pelvic lymph node dissection, 59 (60.2%) patients pelvic + paraaortic lymph node dissection and we do not have any patients who were opereted including only paraaortic lymph node dissection.
In 7 (7.6%) patients, only pelvic lymph node metastasis and in 5 (5.4%) patients, pelvic + paraaortic lymph node metastasis were detected. None of 76 (83.5%) patient had lymph node metastases.
42 (42.9%) patients of the study had less than ½ myometrial invasion depth and 56 (57.1%) had more than ½ and we did not detect any patients who has not myometrial invasion.
We found 56 patients (57.1%) with a myometrial invasion depth greater than ½ and 25 of this patients had lower uterine segment involvement. 42 (42.9%) patients with less than ½ of the depth of myometrial invasion had no lower uterine segment involvement. The difference between the results was statistically significant (p = 0.030).
In 43 patients (43.8%) the tumor diameter was less than 4 cm and 55 (56.1%) had tumor diameter greater than 4 cm. Lower uterine segment involvement was detected in 38 of 55 (56.1%) patients with a tumor diameter greater than 4 cm. There was no lower uterine segment involvement in 43 (43.8%) patients with a tumor diameter less than 4 cm. This was also statistically significant (p = 0.001).
It was also observed that other prognostic factors; lymphovascular invasion (p = 0.852), tumor grade (p = 0.392) and age (p = 0.543) were not associated with lower uterine segment involvement.
Conclusion: Myometrial invasion depth more than 50% was statistically significant as a prognostic factor for lower uterine segment involvement in follow-up pathology results including the patients who were operated with lymph node dissection due to endometrium carcinoma. The size of tumor diameter (> 4 cm) and pelvic lymph node invasion was also found to be statistically significant for lower uterine segment involvement. Furthermore, lower uterine segment involvement was not an independent prognostic factor for LVAI, tumor grade, and age.