宫颈癌盆腔淋巴结高危型HPV分布及其临床意义的探讨  

Distribution of high-risk HPV and its effect on prognosis of pelvic lymph nodes metastasis in cervical cancer

作　　者：何善阳[1] 袁力[1] 李捷[1] 沈丽萍[1] 游泽山[1] 姚书忠[1] 

机构地区：[1]中山大学附属第一医院妇产科,广东广州510700

出　　处：《中华肿瘤防治杂志》2011年第16期1259-1261,1295,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：广东省科技厅基金资助(2010B031600059)

摘　　要：目的:探讨早期宫颈癌盆腔淋巴结中高危型人乳头瘤病毒(HR-HPV)的分布及其预测淋巴转移的价值。方法:采用第2代杂交捕获技术(HC-Ⅱ)对新鲜的盆腔淋巴结进行13种HR-HPV DNA的检测,分析HR-HPV与病理结果的关系。结果:38例早期宫颈癌患者原发肿瘤中,HR-HPV阳性37例(97.4%),盆腔淋巴结阳性23例(60.5%),组织病理学确诊有淋巴结转移18例(47.4%),HR-HPV阳性与淋巴结阳性分布规律呈一致性,以闭孔淋巴结较多见。有盆腔淋巴结转移的HPV-DNA阳性率为73.9%,HPV-DNA阴性率为6.7%,差异有统计学意义,P<0.001。HR-HPV诊断早期宫颈癌发生盆腔淋巴转移的敏感度和特异度分别为94.4%和70.0%,阳性预测价值和阴性预测价值分别为73.9%和93.3%;HR-HPV阳性发生盆腔淋巴结转移的风险是HR-HPV阴性的39.67倍〔OR(95%CI)=39.67(4.26～369.65)〕。结论:HC-Ⅱ检测淋巴结中HR-HPV是敏感的且不破坏淋巴组织,检测HR-HPV是预测宫颈癌淋巴结转移的重要因素,但判断宫颈癌复发尚需进一步探讨。OBJECTIVE：To investigate the distribution and prognosis of metastasis of high-risk HPV（HR-HPV） in pelvic lymph nodes in cervical cancer.METHODS： The correlation between the presence of HR-HPV and pathological results in pelvic lymph nodes were analyzed by hybrid capture-Ⅱ（HC-Ⅱ） in fresh tissue.RESULTS： Altogether,38 patients were enrolled in the study.HR-HPV DNA was identified in the prime tumor in 37 patients（97.4%） and in 23 patients（60.5%） with positive HR-HPV and 18 patients（47.4%） with metastatic lymph nodes were proved by pathology.There was a coordinate distribution between the HR-HPV and metastatic lymph nodes,especially in obturator fossa.Metastatic lymph nodes and the volume of prime tumor were both important factor of positive HR-HPV in lymph nodes.There was significant difference between the rate of positive HPV-DNA with metastatic lymph nodes（73.9%） and of negative HPV-DNA（6.7%,P0.001）.HR-HPV could be used to diagnosed metastatic lymph nodes in early cervical cancer with the 94.4% sensitivity and 70.0% specificity,respectively and with 73.9% positive predictive value and 93.3%negative predictive value respectively.The risk of metastasis of lymph nodes in patients with the positive HR-HPV was 39.67 fold than that of patients with the negative（OR（95% CI）=39.67（4.26-369.65））.CONCLUSIONS： It suggestes that HR-HPV DNA testing by HC-Ⅱin lymph nodes is a sensitive and important prognosis factor for lymph nodes metastasis.HR-HPV DNA testing can avoid any loss of material for histology.However,its ability of recurrence evaluation needs further studies.

关 键 词：高危型人乳头瘤病毒 盆腔淋巴结 淋巴转移 复发 

分 类 号：R737.33[医药卫生—肿瘤]