IB～IIB期宫颈癌盆腔淋巴结转移相关因素分析

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1281 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：分析IB～IIB期宫颈癌盆腔淋巴结转移情况及相关高危因素，为早期宫颈癌的手术方式提供参考。方法：对158例进行广泛性全子宫切除术联合盆腔淋巴结清扫的IB～IIB期宫颈癌患者的临床病理资料进行回顾性分析，对影响淋巴结转移的因素采用logistic回归分析。结果：158例IB～IIB期宫颈癌有36例淋巴结转移阳性，转移率为22.8%，其中闭孔淋巴结转移22例（占13.9%），髂内淋巴结转移15例（占9.5%），髂外淋巴结转移10例（占6.3%），髂总淋巴结转移7例（占4.4%），腹股沟深淋巴结转移4例（占2.5%），宫旁淋巴结转移1例（占0.6%），腹主动脉旁淋巴结转移1例（占0.6%）。21例孤立淋巴结阳性，15例多组淋巴结阳性。单因素分析结果显示肿瘤直径大小超过4 cm，术前鳞状细胞癌抗原（SCC-Ag）及宫旁浸润与盆腔淋巴结转移相关（P＜0.05）。logistic回归分析结果显示肿瘤直径超过4 cm及宫旁浸润是盆腔淋巴结转移的独立危险因素（P＜0.05）。结论：IB～IIB期宫颈癌盆腔淋巴结转以闭孔淋巴结最易受累，肿瘤直径超过4 cm及宫旁浸润是盆腔淋巴结转移的高危因素。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈慧君1
	黄亦波1
	林蓉蓉1
	郑飞云2

关键词 ：宫颈肿瘤, 盆腔淋巴结转移, 肿瘤大小, 宫旁浸润, 回归分析

Abstract：

Objective: To analysis the factors affecting lymph node metastasis in stage IB1 to IIB uterine cervical cancer. Methods: A total of 158 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively analyzed. The logistic multivariate analysis was used to select independent high-risk factors. Results: Thirty-six (22.8%) patients had pelvic lymph node metastasis. Of 36 lymph node metastases, 22 were in the obturator, 15 in the internal iliac, 10 in the external iliac, 7 in the common iliac, 4 in the deep inguinal, 1 in the parametrial iliac and 1 in the para aortic. Univariate analysis revealed that tumor size, preoperative SCC-Ag level and parametrial invasion were related to pelvic lymph node metastasis. Multivariate analysis revealed that tumor size greater than 4 cm and parametrial invasion were independently associated with nodal metastasis. Conclusion: The obturator lymph nodes are most frequently involved in stage IB～IIB uterine cervical cancer. Tumor size greater than 4 cm and parametrial invasion are high-risk factors of pelvic lymph node metastasis.

Key words： uterine cervical neoplasms pelvic lymph node metastasis tumor size parametrial invasion: regression analysis

收稿日期: 2014-08-31

基金资助:浙江省自然科学基金资助项目（Y2090699）。

通讯作者: 郑飞云，教授，Email：zfy5710@163.com。

作者简介: 陈慧君（1990-），女，浙江苍南人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I4/248

[1] Cormier B, Diaz JP, Shih K, et al. Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer[J]. Gynecol Oncol, 2011, 122(2): 275-280.
[2] Roy M, Bouchard-Fortier G, Popa I, et al. Value of sentinel node mapping in cancer of the cervix[J]. Gynecol Oncol, 2011, 122(2): 269-274.
[3] Bergmark K, Avall-Lundqvist E, Dickman PW, et al. Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls[J]. Int J Gynecol Cancer, 2006, 16(3): 1130-1139.
[4] Tada H, Teramukai S, Fukushima M, et al. Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma[J]. BMC Cancer,2009, 9(47): 1-6.
[5] Frumovitz M, Sun CC, Schmeler KM, et al. Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer[J]. Obstet Gynecol, 2009, 114(1): 93-102.
[6] Kodama J, Kusumoto T, Nakamura K, et al. Factors associated with parametrial involvement in stage IB1 cervical cancer and identification of patients suitable for less radical surgery[J]. Gynecol Oncol, 2011, 122(3): 491-494.
[7] Murakami I, Fujii T, Kameyama K, et al. Tumor volume and lymphovascular space invasion as a prognostic factor in early invasive adenocarcinoma of the cervix[J]. J Gynecol Oncol, 2012, 23(3): 153-158.
[8] Meirovitz M, Sade S, Dreiher J, et al. Is radical hysterectomy necessary in early cervical cancer?[J]. Gynecol Obstet Invest, 2013, 76(3): 158-162.
[9] Hosaka M, Watari H, Mitamura T, et al. Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy [J]. Int J Clin Oncol, 2011, 16(1): 33-38.
[10] Kasamatsu T, Onda T, Sawada M, et al. Radical hysterectomy for FIGO stage I-IIB adenocarcinoma of the uterine cervix [J]. Br J Cancer, 2009, 100(9): 1400-1405.
[11] Lee J, Song Y, Soh EY. Prognostic significance of th number of metastatic lymph nodes to stratify the risk of recurrence[J]. World J Surg, 2014, 38(4): 858-862.
[12] Sakuragi N. Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer[J]. Int J Clin Oncol, 2007, 12(3): 165-175.
[13] Pieterse QD, Maas CP, Ter Kuile MM, et al. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer[J]. Int J Gynecol Cancer, 2006, 16(3): 1119-1129.
[14] 陈映鹤, 木海琦, 何有华, 等. 妇产科手术致泌尿系统器官损伤的原因及防治[J]. 温州医学院学报, 2010, 40(5): 487-489.
[15] Togami S, Kamio M, Yanazume S, et al. Can pelvic lymphadenectomy be omitted in stage IA2 to Iib uterine cervical cancer?[J]. Int J Gynecol Cancer, 2014, 24(6): 1072-1076.
[16] Takeda M, Sakuragi N, Okamoto K, et al. Preoperative serum SCC, CA125, and CA19-9 levels and lymph node status in squamous cell carcinoma of the uterine cervix[J]. Acta Obstet Gynecol Scand, 2002, 81(5): 451-457.
[17] Turan T, Yildirim BA, Tulunay G, et al. Prognostic effect of different cut-off values (20mm, 30mm and 40mm) for clinical tumor size in Figo Stage IB cervical cancer[J]. Surg Oncol, 2010, 19(2): 106-113.
[18] 李洋. Ia~IIb期宫颈癌盆腔淋巴结转移高危因素的临床分析[J].中国妇幼保健, 2013, 28(22): 3584-3586.
[19] 万磊, 李隆玉, 曾四元, 等. 宫颈鳞癌淋巴结转移的高危因素分析[J]. 中国妇幼保健, 2014, 29(4): 528-529.
[20] Singh P, Tripcony L, Nicklin J, et al. Analysis of prognostic variables, development of predictive models, and stratification of risk groups in surgically treated FIGO early-stage (IA-IIA) carcinoma cervix[J]. Int J Gynecol Cancer, 2012,22(1): 115-122.
[21] Khunamornpong S, Lekawanvijit S, Settakorn J, et al. Prognostic model in patients with early-stage squamous cell carcinoma of the uterine cervix: a combination of invasive margin pathological characteristics and lymphovascular space invasion[J]. Asian Pac J Cancer Prev, 2013, 14(11): 6935-6940.
[22] Milam MR, Frumovitz M, dos Reis R, et al. Preoperative lymph-vascular space invasion is associated with nodal metastases in women with early-stage cervical ancer[J]. Gynecol Oncol, 2007, 106(1): 12-15.
[23] Diaz JP, Gemignani ML, Pandit-Taskar N, et al. Sentinel lymph node biopsy in the management of early-stage cervical carcinoma[J]. Gynecol Oncol, 2011, 120(3): 347-352.
[24] Martinez A, Mery E, Filleron T, et al. Accuracy of intraoperative pathological examination of SLN in cervical cancer[J].Gynecol Oncol, 2013, 130(3): 525-529.
[25] Altgassen C, Hertel H, Brandstadt A, et al. Multicenter validation study of the sentinel lymph node concept in cervical cancer: ago study group[J]. J Clin Oncol, 2008, 26(18): 2943-2951.
[26] Eiriksson LR, Covens A. Sentinel lymph node mapping in cervical cancer: the future?[J]. BJOG, 2012, 119(2): 129-133.