手术分期与影像学分期对局部晚期宫颈癌治疗及预后的影响  

Effects of Surgical Staging and Imaging staging on Treatment and Prognosis of Locally Advanced Cervical Cancer

作　　者：康海利[1] 赵群[1] 李凤霜[1] 段微[1] KANG Haili;ZHAO Qun;LI Fengshuang;DUAN Wei(Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇瘤科,北京100006

出　　处：《医学综述》2022年第3期605-609,614,共6页Medical Recapitulate

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201705)。

摘　　要：目的探讨手术分期与影像学分期对局部晚期宫颈癌患者放疗预后的影响及影像学评估淋巴结转移的准确性。方法收集2015年5月至2017年11月在首都医科大学附属北京妇产医院妇瘤科接受手术分期及放疗的23例ⅠB2~ⅢB期宫颈鳞状细胞癌患者的病例资料及随访结果,随机选取同期进行影像学分期及放疗且资料完整的46例宫颈鳞状细胞癌患者作为对照,根据2019年国际妇产科联盟分期标准再次分期,对比两种分期方法对放疗及预后的影响,评估CT/磁共振成像(MRI)判断淋巴结转移的准确性。结果从疾病诊断至治疗结束,手术分期组时间(77±6)d,影像学分期组时间(69±5)d;手术分期组手术至放疗开始时间(8.4±1.8)d。手术分期组放疗后下肢水肿发生率高于影像学分期组[43.5%(10/23)比8.7%(4/46)](χ^(2)=11.470,P=0.001)。与术后病理结果对比,手术分期组术前CT/MRI评估淋巴结转移的灵敏度为71.4%(10/14),特异度为81.3%(13/16),有4例患者根据术后病理结果分期升级,3例患者分期降级。随访时间8~40个月,平均(31±8)个月,手术分期组3年无进展生存率为78.3%,影像学分期组为51.9%,两组比较差异有统计学意义(P<0.05);手术分期组3年总生存率为81.8%,影像学分期为66.2%,两组比较差异无统计学意义(P>0.05)。结论与影像学分期相比,手术分期能够得到更准确的淋巴结转移结果,从而决定放射剂量及放射野,根据手术分期指导放疗能明显降低宫颈癌复发率。Objective To investigate the effect of surgical staging and imaging staging on the prognosis of radiotherapy in patients with locally advanced cervical cancer,and the accuracy of imaging assessment of lymph node metastasis.Methods The case data and follow-up results of 23 patients with stageⅠB2-ⅢB cervical squamous cell carcinoma who underwent surgical staging and radiotherapy at Department of Gynecologic Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University from May 2015 to Nov.2017 were collected.A total of 46 cases with cervical squamous cell carcinoma for imaging staging and radiotherapy with complete case data during the same time period were randomly selected as a control group,which were re-staged according to the 2019 International Federation of Gynecology and Obstetrics staging standard.The effects of the two staging methods on radiotherapy and prognosis were compared,and the accuracy of CT/magnetic resonance imaging(MRI)in judging lymph nodes was assessed.Results The time from diagnosis to end of treatment was(77±6)d in the surgical staging group and(69±5)d in the imaging staging group.The time from operation to radiotherapy start in the surgical staging group was(8.4±1.8)d.The incidence of lower limb edema after radiotherapy in the surgical stage group was higher than that in the imaging stage group[43.5%(10/23)vs 8.7%(4/46)](χ^(2)=11.470,P=0.001).Compared with postoperative pathological results,the sensitivity and specificity of preoperative CT/MRI assessment of lymph node metastasis in the surgical staging group were 71.4%(10/14)and 81.3%(13/16),with 4 patients staging upgrade and 3 patients staging degradation according to postoperative pathological results.The follow-up time was 8-40 months,with an average of(31±8)months.The 3-year progression-free survival rate was 78.3%in the surgical staging group and 51.9%in the imaging staging group,and the difference between the two groups was statistically significant(P<0.05).The 3-year overall survival rate of the surgical

关 键 词：局部晚期宫颈癌 手术分期 影像学分期 

分 类 号：R737[医药卫生—肿瘤]