Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Turkey
Approval Date: 2017
Thesis Language: Turkish
Student: Yağmur Soykan
Supervisor: MEHMET ANIL ONAN
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.