宫颈癌根治术后盆腔淋巴结转移的预后研究  

Prognosis of Patients with Stage Ⅰb- Ⅱb Node-Positive Cervical Carcinoma

作　　者：程玺[1] 蔡树模[1] 李子庭[1] 唐美琴[1] 薛木泉[1] 臧荣余[1] 

机构地区：[1]复旦大学附属肿瘤医院妇瘤科,上海200032

出　　处：《癌症》2003年第11期1219-1223,共5页Chinese Journal of Cancer

摘　　要：背景与目的:盆腔淋巴结转移是影响宫颈癌预后的重要因素,但是淋巴结阳性数、淋巴结转移部位及术后辅助治疗与预后的关系,尚有待探讨。本研究拟探讨Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时影响预后的危险因素。方法:回顾性分析66例根治术后证实有盆腔淋巴结转移的Ⅰb～Ⅱb期(FIGO分期)宫颈癌患者的临床资料,对可能影响预后的有关因素进行Cox比例风险模型分析。结果:66例盆腔淋巴结转移患者的5年总生存率为40.7％。Cox比例风险模型分析结果显示:肿瘤分化程度、淋巴结转移数目和术后辅助治疗是影响预后的重要危险因素(P<0.05)。1枚淋巴结转移患者的5年总体生存率(56.5％)明显高于2枚或2枚以上淋巴结转移的患者(36.4％)(P<0.05),前者远处转移率(5.9％)低于后者(32.7％)(P=0.05),而两组患者盆腔复发率无显著性差异(P>0.05)。术后未予辅助治疗患者的5年生存率(12.6％)明显低于术后辅助治疗者(53.7％)(P< 0.05),而辅助放疗组、辅助化疗组与辅助放化疗组患者的5年生存率差异无统计学意义(P>0.05)。结论:Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时预后差,术后辅助治疗能提高患者生存率,减少盆腔复发和远处转移。BACKGROUND & OBJECTIVE: Pelvic lymph node metastasis was the important prognostic factor for the patients with cervical carcinoma. However, the relationship among the number of positive nodes, site of metastatic nodes, adjuvant therapy, and the prognosis were unknown. The purpose of this study was to investigate the variables that could predict the prognosis of the patients with stage Ⅰ b- Ⅱ b node-positive cervical carcinoma. METHODS: Sixty-six patients with stage Ⅰ b- Ⅱ b cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy were analyzed retrospectively. Potential prognostic variables were studied by Cox proportional hazard model. RESULTS: The 5-year survival rate of the patients with pelvic lymph node metastasis was 40. 7%. Cox proportional hazard model analysis showed cellular differentiation, number of positive nodes, and adjuvant therapy were the important prognostic factors ( P <0. 05). The 5-year survival rate of patients with one positive node (56. 5% ) was higher than that (36. 4% ) of those with two or more positive nodes ( P <0. 05) . The former's distant metastatic rate (5. 9% ) was lower than the letter's (32.7%) (P = 0.05). However, there was no difference of pelvic recurrence between them ( P > 0. 05) . The 5-year survival rate of the patients who had no adjuvant therapy (12. 6% ) was much lower than that (53. 7% ) of those with adjuvant therapy ( P <0. 05). However, the differences of the effects among adjuvant radiotherapy, chemotherapy, and chemoradiotherapy were not obvious ( P > 0. 05). CONCLUSION: The prognosis of patients with stage Ⅰb-Ⅱb node-positive cervical carcinoma who underwent radical surgery was poor. Adjuvant therapy can improve the survival rate, decrease the pelvic recurrence and distant metastasis.

关 键 词：宫颈癌 根治术 术后 盆腔淋巴结转移 预后 影响因素 

分 类 号：R737.33[医药卫生—肿瘤] R730.56[医药卫生—临床医学]