Kamura T, Shigematsu T, Kaku T, Shimamoto T, Saito T, Sakai K, Mitsumoto M, Nakano H
Department of Gynecology and Obstetrics, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Acta Obstet Gynecol Scand. 1999 May;78(5):452-7.
Lymph node metastasis has been one of the strongest prognostic factors in patients with cervical cancer. In order to select patients with high risk for recurrence, a relationship between status of lymph node and other histopathological parameters was investigated in the patients treated with radical hysterectomy with pelvic lymph adnectomy.
Of 483 patients undergoing radical hysterectomy with pelvic lymph adnectomy, 309 had stage Ib disease, 62 stage IIa, and 112 stage IIb.
Pelvic lymph node metastasis(PLNM) was positive in 98 patients (20%). Of those positive patients, 51(56%) had metastasis in one site, 25 (26%) in two sites, and 22 (22%) in three or more sites. There was a significant difference in survival between patients with metastasis in one or no sites and those in two or more sites (p<0.0001). There was a relationship between PLNM in more than two sites and histological parameters such as histologic subtype, longitudinal diameter of cervical lesion, degree of stromal invasion, depth of stromal invasion, lymph-vascular space invasion, parametrial invasion, and corpus invasion. All of these parameters except for histologic subtype were significantly correlated with the number of positive lymph node sites. Multivariate analysis revealed that among these parameters, longitudinal diameter of the cervical lesion, parametrial invasion, and lymph-vascular space invasion were independently significantly correlated with PLNM in two or more sites.
From these results, patients having these three histopathological parameters could be considered as those with extensive disease distribution.
淋巴结转移一直是宫颈癌患者最强的预后因素之一。为了筛选出复发风险高的患者，我们在接受根治性子宫切除术加盆腔淋巴结清扫术的患者中研究了淋巴结状态与其他组织病理学参数之间的关系。
在483例行根治性子宫切除术加盆腔淋巴结清扫术的患者中，309例为Ib期疾病，62例为IIa期，112例为IIb期。
98例患者（20%）盆腔淋巴结转移（PLNM）呈阳性。在这些阳性患者中，51例（56%）转移至一个部位，25例（26%）转移至两个部位，22例（22%）转移至三个或更多部位。转移至一个或无转移部位的患者与转移至两个或更多部位的患者之间的生存率存在显著差异（p<0.0001）。两个以上部位的PLNM与组织学亚型、宫颈病变纵径、间质浸润程度、间质浸润深度、淋巴管间隙浸润、宫旁浸润和宫体浸润等组织病理学参数之间存在关联。除组织学亚型外，所有这些参数均与阳性淋巴结部位数量显著相关。多因素分析显示，在这些参数中，宫颈病变纵径、宫旁浸润和淋巴管间隙浸润与两个或更多部位的PLNM独立显著相关。
根据这些结果，具有这三种组织病理学参数的患者可被视为疾病分布广泛的患者。
