早期宫颈癌髂总淋巴结转移相关因素及预后临床分析  

Risk factors and prognosis clinical analysis of common iliac lymph nodes in patients with stageⅠB1 and ⅡA2 cervical cancer

作　　者：李慧芹[1] 尹月菊 盛修贵[1] 李兴兰[1] 杜雪莲[1] 韩晓运[1] 

机构地区：[1]山东省肿瘤医院妇瘤科,山东济南250117

出　　处：《中华肿瘤防治杂志》2015年第11期871-874,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨ⅠB1~ⅡA2期宫颈癌髂总淋巴结转移的相关因素及预后,为指导临床治疗提供依据。方法回顾性分析1997-06-12-2013-06-30山东省肿瘤医院收治的行广泛子宫切除＋盆腔淋巴清除术284例ⅠB1~ⅡA2期宫颈癌患者的临床病理资料。结果在284例患者中有盆腔淋巴结转移82例,转移率为28.9%。其中髂总淋巴结转移率为5.3%（15/284）,腹主动脉旁淋巴结转移率为2.8%（8/284）。单因素分析显示,淋巴血管间隙浸润、盆腔其他淋巴结转移是髂总淋巴结转移的危险因素,P〈0.05。多因素分析显示,盆腔其他淋巴结转移为髂总淋巴结转移的独立危险因素,OR=35.41,P=0.001。髂总淋巴结阳性患者5年总生存率为21.2%。多因素分析显示,淋巴血管间隙浸润（OR=2.6,P=0.01）及腹主动脉旁淋巴结转移（OR=9.3,P〈0.01）均为早期宫颈癌髂总淋巴结转移患者5年生存率的独立影响因素。结论早期宫颈癌髂总淋巴结转移率较低,盆腔其他淋巴结转移是其独立高危因素,而且髂总淋巴结转移患者预后较差。若术后病理显示髂总淋巴结转移患者,在补充放化疗时,建议采用调强适形放疗,同时建议其靶区勾画的范围上界达到腹主动脉旁。OBJECTIVE To investigate the clinicopathological factors and prognosis of early stage cervical cancer patients with common iliac lymph node metastasis.METHODS Two hundred eighty-four patients with stageⅠB1to ⅡA2cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy in Shandong Cancer Hospital between June 12,1997 and June 30,2013,and the pathological and clinical features were retrospectively reviewed.RESULTS The metastatic rate was 28.9%（82/284）in the pelvic lymph nodes and 5.3%（15/284）was in the common iliac lymph nodes.Univariate analysis revealed that other PLNs（including lymph nodes collected from obturator,external iliac,and internal iliac regions）and lymph vascular space involvement were the risk factors of common iliac lymph node metastases（P〈0.05）.Other PLN metastasis（OR=35.41,P=0.001）was an independent risk factor for metastasis to common lymph nodes by binary logistic regression analysis.The 5-year OS was 21.2%in patients with positive common lymph nodes.Multivariate analysis showed lymph vascular space involvement（OR=2.6,P=0.01）and para-aortic（OR=9.3,P〈0.01）lymph node metastasis were the independent factors to influence the 5-year OS of the early stage cervical cancer patients with common lymph node metastasis.CONCLUSIONS In early stage cervical cancer,common lymph node metastasis is low,especially when other PLN is negative.Other PLN metastasis is an independent risk factor for metastasis to common lymph nodes.Patients with common lymph node metastasis have poor prognosis.But if common lymph nodes metastasis found by postoperative pathological diagnosis,we suggest the radiation therapy field expanded the para-aortic region.

关 键 词：宫颈肿瘤 淋巴结切除术 髂总淋巴结 转移 

分 类 号：R737.33[医药卫生—肿瘤]