Endometrium kanserinde lenfovasküler saha invazyonuile ilgili faktörler ve lenfovasküler sahainvazyonunun miyometrial invazyon, alt uterin segmenttutulumu, servikal tutulum ve lenf nodu metastazı ileilişkisinin incelenmesi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Endometrium kanserinde lenfovasku?ler saha invazyonu (LVSİ) ile ilgili faktörler ve lenfovasku?ler saha invazyonunun miyometrial invazyon (Mİ), alt uterin segment tutulumu, servikal tutulum ve lenf nodu metastazı ile ilişkisi incelenmiş olup, lenfovasku?ler saha invazyonunun endometrium kanseri için yeni bir prognostik belirteç olarak kullanılıp kullanılamayacağının araştırılması amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde 2015-2021 yılları arasında endometrium kanseri nedeniyle total histerektomi + bilateral salpingooferektomi ± Pelvik ve/veya Paraaortik lenfadenektomi + omentektomi yapılmış 44 hasta çalışmaya dahil edilmiş ve patoloji sonuçlarına göre LVSİ pozitif olan ve olmayan olmak u?zere 2 gruba ayrılmıştır. LVSİ olmayan 29 hasta kontrol grubu ve LVSİ pozitif olan 15 hasta çalışma grubu olarak belirlenmiştir. Hastalar yaş, ameliyat tipi, gravida, parite, menopoz durumu, malignite öyku?su?, ailede malignite öyku?su?, sistemik hastalık, ilaç kullanımı, operasyon öyku?su?, başvuru şikayeti, preop endometrial örnekleme sonucu, yapılan ameliyatlar, patolojik tanısı, cerrahi evreleri ve patoloji sonuçları univaryan ve multivaryan analizler yapılarak karşılaştırılmıştır. Bulgular: Gruplar arasında yaş, gravida, parite, menopoz durumu, malignite öyku?su?, malignite tipi, ailede malignite öyku?su? ve tipi, sistemik hastalık varlığı, başvuru şikayeti, preoperatif endometrial örnekleme sonuçları, ana materyal patoloji, uterus çapı, tu?mör çapı, Mİ varlığı, alt uterin segment tutulumu, servikal tutulum, paraaortik lenf nodu tutulumu, ana materyal batın yıkama sıvında tu?mör varlığı ve prognoz açısından sonuçları karşılaştırılmış ve istatistiksel olarak anlamlı fark bulunamamıştır iv (Sırasıyla p=0,657, p=0,773, p=0,930, p=0,957, p=0,925, p=0,999, p=0,822, p=0,571, p=0,675, p=0,414, p=0,846, p=0,083, p=0,328 ve p<0,05). Her iki grup histolojik grade, nu?kleer grade, Mİ derinliğinin, pelvik lenf nodu tutulumu ve ana material cerrahi evre açısından karşılaştırılmış ve istatistiksel olarak anlamlı bulunmuştur. LVSİ pozitif olan çalışma grubunda ana materyal histolojik ve nu?kleer grade açısından bakıldığında istatistiksel olarak anlamlı olacak şekilde daha fazla oranda grade 3 tu?möre sahip olduğu tespit edilmiştir (p=0,001 ve p<0,05). LVSİ olan çalışma grubunda istatistiksel olarak kontrol grubuna göre ana materyal nu?kleer grade açısından anlamlı sonuç bulunmuştur (p=0,001 ve p<0,05). Mİ varlığı açısından her iki grup arasında istatistiksel olarak anlamlı farklılık bulunamamış (p=0,999 ve p<0,05) olmasına rağmen Mİ varlığında LVSİ pozitif olan çalışma grubunda Mİ derinliğinin anlamlı olarak ½'den daha fazla olduğu tespit edilmiştir (p=0,001 ve p<0,05). Sağ ve sol pelvik lenf nodu tutulumu açısından LVSİ pozitif olan grupta istatistiksel olarak anlamlı sonuç bulunmuştur (Sağ pelvik lenf nodu için p=0,003 ve p<0,005, sol pelvik lenf nodu için p=0,001 ve p<0,05). Her iki grup ana materyal cerrahi evrelendirme açısından karşılaştırıldığında LVSİ pozitif olan grupta daha ileri evre hastalık olduğu istatistiksel olarak anlamlı sonuç bulunmuştur (p=0,009 ve p<0,05). Sonuç: Endometrium kanserinde LVSİ'nin prognostik öneminin yeri birçok çalışmada araştırılmış olmasına rağmen kesin bir fikir birliğine varılamamıştır. Çalışmamızın sonucunda LVSİ varlığının histolojik grade, nu?kleer grade, Mİ derinliği, pelvik lenf nodu tutulumu ve daha ileri evre hastalık açısından istatistiksel olarak anlamlı etkisi olduğunu gözlemledik. Bu konuda daha çok vaka sayılı ve daha uzun takip su?reli çalışmalara ihtiyaç duyulmaktadır.
Objective: Having investigated the factors related to lymphovascular space invasion (LVSI) in endometrium cancer and the relations between LVSI and myometrial invasion (MI), lower uterus segment involvement, cervical involvement and lymph nodule metastasis, the purpose of this research is to investigate whether or not LVSI can be used as a new prognostic metric in endometrium cancer. Materials and Methods: 44 patients had gone under hysterectomy + bilateral salpingo-oophorectomy ± pelvic and/or paraaortic lymphadenectomy + omentectomy procedures due to being diagnosed with endometrium cancer between 2015-2021 in our clinic, and according to the pathological results, the patients were divided in to two groups of LVSI positives and negatives. The control group of 29 patients without LVSI and the experimental group of 15 patients with LVSI were identified for the study. The patients were compared according to the analyses done over age, surgery type, gravida, parity, menopause state, malignancy history, malignancy history of family, systematic illnesses, medical drug use, medical operation history, symptomatic complaints, pre-operational endometrial sample analysis results, completed surgeries, pathological diagnosis, surgical stages, pathological results, univariant and multivariant results. Result: The results between the groups were compared according to age, gravida, parity menopause state, malignancy history, malignancy history of family, systematic illnesses, symptomatic complaints, pre-operational endometrial sample analysis results, main material pathology, uterus radius, tumour radius, MI presence, segment involvement of lower uterus, cervical involvement, paraaortic lymph nodule vi involvement, presence of tumour in main material peritoneal cytology and prognosis. According to the statistical analysis no meaningful differences were found (p=0,657, p=0,773, p=0,930, p=0,957, p=0,925, p=0,999, p=0,822, p=0,571, p=0,675, p=0,414, p=0,846, p=0,083, p=0,328 and p<0,05). Two groups were compared with respect to histological grade, nuclear grade, MI depth, pelvic lymph nodule involvement and main material surgical state, and the results were found statistically meaningful. When considered by taking histological and nuclear grade into account, the statistical results showed that the experimental group of patients who had LVSI had a higher rate of grade 3 tumour (p=0,001 and p<0,05). Meaningful statistical results were found with respect to nuclear grade in the LVSI positive patients of the experimental (p=0,001 and p<0,05). Even though no statistically meaningful results were found considering MI presence (p=0,999 and p<0,05), in the presence of MI among the experimental group, the depth of MI is identified to be above ½ (p=0,001 and p<0,05). Likewise, meaningful results were found when the experimental group of LVSI positive patients were considered by taking left and right pelvic nodule involvement into account (for the right pelvic lymph nodule p=0,003 and p<0,005, for the left lymph nodule p=0,001 and p<0,05). Finally, when both groups were compared with respect to the main material surgical staging, it was statistically shown that the LVSI positive patients appeared to have a more mature state of the disease (p=0,009 and p<0,05). Conclusion: Although LVSI's prognostic importance in endometrium cancer was investigated in many research, there is no consensus on its crucial role in the development of endometrium cancer. As a result of our research, we have statistically shown how the presence of LVSI meaningfully impacts histological grade, nuclear grade, MI depth, pelvic lymph nodule involvement and maturity of the disease. Further study with more patients and a longer follow-up period is still needed in this research subject.
Objective: Having investigated the factors related to lymphovascular space invasion (LVSI) in endometrium cancer and the relations between LVSI and myometrial invasion (MI), lower uterus segment involvement, cervical involvement and lymph nodule metastasis, the purpose of this research is to investigate whether or not LVSI can be used as a new prognostic metric in endometrium cancer. Materials and Methods: 44 patients had gone under hysterectomy + bilateral salpingo-oophorectomy ± pelvic and/or paraaortic lymphadenectomy + omentectomy procedures due to being diagnosed with endometrium cancer between 2015-2021 in our clinic, and according to the pathological results, the patients were divided in to two groups of LVSI positives and negatives. The control group of 29 patients without LVSI and the experimental group of 15 patients with LVSI were identified for the study. The patients were compared according to the analyses done over age, surgery type, gravida, parity, menopause state, malignancy history, malignancy history of family, systematic illnesses, medical drug use, medical operation history, symptomatic complaints, pre-operational endometrial sample analysis results, completed surgeries, pathological diagnosis, surgical stages, pathological results, univariant and multivariant results. Result: The results between the groups were compared according to age, gravida, parity menopause state, malignancy history, malignancy history of family, systematic illnesses, symptomatic complaints, pre-operational endometrial sample analysis results, main material pathology, uterus radius, tumour radius, MI presence, segment involvement of lower uterus, cervical involvement, paraaortic lymph nodule vi involvement, presence of tumour in main material peritoneal cytology and prognosis. According to the statistical analysis no meaningful differences were found (p=0,657, p=0,773, p=0,930, p=0,957, p=0,925, p=0,999, p=0,822, p=0,571, p=0,675, p=0,414, p=0,846, p=0,083, p=0,328 and p<0,05). Two groups were compared with respect to histological grade, nuclear grade, MI depth, pelvic lymph nodule involvement and main material surgical state, and the results were found statistically meaningful. When considered by taking histological and nuclear grade into account, the statistical results showed that the experimental group of patients who had LVSI had a higher rate of grade 3 tumour (p=0,001 and p<0,05). Meaningful statistical results were found with respect to nuclear grade in the LVSI positive patients of the experimental (p=0,001 and p<0,05). Even though no statistically meaningful results were found considering MI presence (p=0,999 and p<0,05), in the presence of MI among the experimental group, the depth of MI is identified to be above ½ (p=0,001 and p<0,05). Likewise, meaningful results were found when the experimental group of LVSI positive patients were considered by taking left and right pelvic nodule involvement into account (for the right pelvic lymph nodule p=0,003 and p<0,005, for the left lymph nodule p=0,001 and p<0,05). Finally, when both groups were compared with respect to the main material surgical staging, it was statistically shown that the LVSI positive patients appeared to have a more mature state of the disease (p=0,009 and p<0,05). Conclusion: Although LVSI's prognostic importance in endometrium cancer was investigated in many research, there is no consensus on its crucial role in the development of endometrium cancer. As a result of our research, we have statistically shown how the presence of LVSI meaningfully impacts histological grade, nuclear grade, MI depth, pelvic lymph nodule involvement and maturity of the disease. Further study with more patients and a longer follow-up period is still needed in this research subject.
Açıklama
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
