Morice P, Castaigne D, Pautier P, Rey A, Haie-Meder C, Leblanc M, Duvillard P
Department of Gynecologic Surgery, Oncology, Biostatistics, Radiotherapy, and Pathology, Institut Gustave Roussy, Villejuif, 94805, France.
Gynecol Oncol. 1999 Apr;73(1):106-10. doi: 10.1006/gyno.1998.5308.
The objectives of this study were to evaluate the interest and the potential therapeutic value of systematic pelvic and paraaortic lymphadenectomy in patients with stage Ib and II cervical carcinoma.
This was a prospective study including 421 patients with cervical cancer treated, from 1985 to 1994, by combined radiation therapy and surgery with systematic pelvic and paraaortic lymphadenectomy.
The overall rate of pelvic lymph-node involvement was 26% (106 patients), and the rate of paraaortic metastases was 8% (32 patients). Pelvic nodal involvement was unilateral in 14% (59 patients) and bilateral in 11% (47 patients). Macroscopic positive nodes were found in 12% (52 patients). In a univariate analysis, a young age (<30 years), a tumor size >/=4 cm, stage II disease, and nodal involvement were associated with significantly decreased survival. The nodal status and the characteristics of positive nodes (number and location) were the most significant prognostic factors. In the multivariate analysis, age, the tumor size, and the site of nodal involvement (pelvic or paraaortic) were prognostic factors. Three-year survival was 94% for patients with negative nodes compared to 64% for patients with positive pelvic nodes and 35% for patients with positive paraaortic nodes (P < 0.0001).
These results confirm the diagnostic and prognostic value of systematic complete lymphadenectomy when planning adjuvant treatment and the therapeutic value of complete removal of bulky positive nodes.
本研究的目的是评估系统性盆腔及腹主动脉旁淋巴结清扫术在Ib期和II期宫颈癌患者中的应用价值及潜在治疗价值。
这是一项前瞻性研究，纳入了1985年至1994年间接受联合放疗及手术并系统性盆腔及腹主动脉旁淋巴结清扫术治疗的421例宫颈癌患者。
盆腔淋巴结受累的总体发生率为26%（106例患者），腹主动脉旁转移率为8%（32例患者）。盆腔淋巴结受累单侧发生率为14%（59例患者），双侧发生率为11%（47例患者）。肉眼可见阳性淋巴结的发生率为12%（52例患者）。单因素分析显示，年轻（<30岁）、肿瘤大小≥4 cm、II期疾病及淋巴结受累与生存率显著降低相关。淋巴结状态及阳性淋巴结的特征（数量和位置）是最显著的预后因素。多因素分析显示，年龄、肿瘤大小及淋巴结受累部位（盆腔或腹主动脉旁）是预后因素。淋巴结阴性患者的三年生存率为94%，盆腔淋巴结阳性患者为64%，腹主动脉旁淋巴结阳性患者为35%（P<0.0001）。
这些结果证实了在规划辅助治疗时系统性完整淋巴结清扫术的诊断和预后价值，以及完整切除肿大阳性淋巴结的治疗价值。
