FACTORS AFFECTING SURVIVABILITY OF PATIENTS WITH GYNECOLOGICAL CANCER WITH DESTRUCTION OF PARA-AORTIC AND PELVIC LYMPHATIC NODES AFTER LYMPHADENECTOMY

Ibragimov A. M.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The aim of the study was to identify factors associated with paraaortic and pelvic LU in patients with endometrial cancer (EC), lymph node metastases (LNM), as well as to assess the survival of patients after lymphadenectomy. Methods. The study included 417 patients with paraaortic and ilicheskom LNM, which 2000-2015 at the Medical faculty of the University Hajitepe had undergone surgical treatment, and 835 patients with endometrial cancer with para-aortic and held pelvically lymph node dissection. After receiving a review of the Ethical Committee of the University of Hajitepe, the research began. All patients were subjected to total abdominal hysterectomy, bilateral salpingoophorectomy, Cytology, pelvically and para-aortic lymphadenectomy. Patients with re were evaluated peritoneum Cytology, clinical and pathological features, age, histological subtype, stage, according to the classification FIGO (13), depth of myometrial invasion, tumor size, lymph vascular invasion (LVAI), cervical coverage, adnexic coverage and MDR. Results. Age included in a study of patients who underwent para-aortic and pelvio lymphadenectomy ranged between 26-86 years (58,8±10,1). The incidence of re has changed dramatically due to age dynamics. Thus, the incidence of re at the age of 20-34 years was 1.5%; 35-44 years – 10.8%; 45-54 years – 19%; 55-64 years – 32.6%; 65-84 years – 22.6%; and at the age of 85 and over 85 years – 13.5%. According to the classification of FIGO (83), stage I was observed in 59% (246 patients), stage II – in 28.1% (117 patients), and stage III – in 11% (46 patients). Otolith was observed in 8 (2,0%) patients. Lymph-vascular invasion was noted in 96 (23.0%), and in 321 (77.0%) – it was not noted. The size of the border for the tumor «primer» was taken as 2 cm. Patients with tumor size «primer» ≤ 2 cm were 127 (30.5%), and > 2 cm – 290 (69.5%). Regardless of the stage, serous, transparent cell adenocarcinomas and patients of stage II-IV should be assigned to a high risk group. Serous or transparent cell re are too aggressive tumors. The relative fiveyear survival rate of patients with serous tumors is 45%, with transparent cell tumors – 65%, and with endometrioid tumors – 91%. There is a serious decrease in the five-year survival of patients with stage III of the disease, compared with patients in the early stages of the disease. The prognosis of re in young patients is usually the most favorable. Although overage does not apply to all patients, it has a negative impact on the survival rate of many of them. The most common symptom of re is abnormal bleeding in the uterus in 75-90% of patients. In 70-80% of patients with the established diagnosis stage I was registered, in 20% – invasion into neighboring organs and lymph nodes, and in 8% – metastases outside the organs. All patients underwent dissection of pelvic and paraaortic lymph nodes. No Association was found between cervical grandular coverage, cervical stromal coverage and isolated paraaortic MDR. In patients with deep myometrial invasion, the ratio of isolated paraaortic MDR is greater than in patients without myometrial invasion. Thus, the distribution and indicators of isolated paraaortic MDR, from the point of view of the therapeutic approach, along with the significance, with the wrong definition of the stage, are completed by an erroneous diagnosis. The interaction of risk factors such as myometrial invasion depth ≥ 50%, cervical spread, LVI, positive peritoneal Cytology and adnexal and omental coverage – with survival and recurrence is very important. And this dramatically increases the survival time of patients.

endometrial cancer, lymphadenectomy, metastasis, lymph nodes

1. Jemal A, Siegel RL, Miller KD, Bray F, Center MM. Globalcancerstatistics. CA Cancer J. Clin. 2011;61(2):69-90.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
3. Fader AN, Broder MS, Fraser IS, Arriba LN, Frasure HE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol. 2009;114(1):121-7.
4. Yaegashi N, Ito K, Niikura H. Lymphadenectomy for endometrial cancer: is paraaortic lymphadenectomy necessary? Int J ClinOncol. 2007;12(3):176-80.
5. Abu-Rustum NR. The incidence of isolated paraaortic nodal metastasis in surgically staged endometrial cancer patients with negative pelvic lymph nodes Gynecol Oncol. 2009;115(2):236-8.
6. Soliman PT, Bull D, Daniels M. Lymphadenectomy during endometrial cancer staging: practice patterns among gynecologic oncologists. Gynecol Oncol. 2010;119(2):291-4.
7. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age oryounger: a clinicopathological analysis. Am J Obstet Gynecol. 2005;193(5):1640-4.
8. Garg G, Meyts BJ, Crosvener ZM. Positive peritoneal cytology is an independent risk-factor in early stage endometrial cancer. Gynecol Oncol. 2013;128(1):77-82.
9. Altay A. Analysis of Metastatic Regional Lymph Node Locations and Predictors of Para-aortic Lymph Node Involvement in Endometrial Cancer Patients at Risk for Lymphatic Dissemination. Int J Gynecol Cancer. 2015;25(4):657-64.
10. Walsh CS, Karlan BY. Lymphadenectomy’s role in early endometrial cancer: prognostic or therapeutic. J Natl Cancer Inst. 2008;100(23):1660-1.
11. Torres ML, Muller GL, Chen LG. Risk factors for developing endometrial cancer after benign endometrial sampling. Obstet Gynecol. 2012;120(5):998-1004.
12. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.
13. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(3):45-57.

«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 125-129 pages, index UDK 618.14-006.6-089

10.29254/2077-4214-2019-2-1-150-125-129