Analysis of Lymph Node Metastasis and Risk Factors in 424 Patients with low-grade endometrioid carcinoma

Purpose: To explore the lymph node metastasis (LNM) of low-grade endometrioid carcinoma (EEC) and its related risk factors, and to analyze the efficacy of related risk factors in predicting LNM. Methods: Data of 424 EEC patients who underwent endometrial cancer staging surgery from January 2019 to June 2024 were retrospectively analyzed. Univariate and multivariate logistic regression were used to analyze the related factors of LNM. The receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of related independent risk factors in predicting LNM. Results: The rate of LNM was 7.8% (33/424). Univariate analysis showed that histological grade, tumor size, depth of myometrial, cervical stromal, lymphovascular space invasion (LVSI), microcystic, elongated, fragmented (MELF), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199)and human epididymis protein 4 (HE4) were associated with LNM of EEC. Logistic regression analysis showed that LVSI, MELF, depth of myometria and CA125were independent risk factors for LNM. The ROC curve area of CA125 and depth of myometria was 0.796 and 0.734. The best cut-off point of CA125 was 31.36 (U/mL), corresponding to the largest Youden index of 53.9%, and its positive likelihood ratio was 5.2. The accuracy of diagnosing LNM by combining CA125 and depth of myometrial is higher than that of either alone. Conclusions: LNM is more likely to occur when there are risk factors such as LVSI positive, MELF invasion pattern, myometrial invasion depth ≥50% and CA125. The accuracy of CA125 combined with depth of myometrial in the diagnosis of LNM is higher than that of either alone. This study has a certain reference value for predicting the risk of LNM and stratified management and treatment for EEC patients.