Kanazawa K, Suzuki T, Tokashiki M
Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Gynecol Oncol. 1999 May;73(2):237-41. doi: 10.1006/gyno.1999.5349.
The aim of this study was to examine whether there is a possible difference in patient survival (1) between node-positive and node-negative groups for Stage I, II, IIIA+B, and IIIC disease and (2) between node-positive Stage I through IIIB disease and Stage IIIC disease.
Medical records of 125 patients with Stage I, II, and III epithelial ovarian cancer were retrospectively analyzed for clinical and histological characteristics with special reference to node-positive or -negative status, and patient survival by lymph node status was compared for FIGO intraperitoneal stage.
One hundred eleven of 125 patients were explored for retroperitoneal and inguinal nodes and divided into a node-positive group [n = 35 (31.5%)] and a node-negative group [n = 76 (68.5%)]. Stage III disease and histological grade 3 disease were significantly more frequent in the node-positive group in comparison with the corresponding figures in the node-negative group (P = 0.0007 and P = 0.0005). The 10-year survival was not significantly different between the node-positive and the node-negative group for each of Stage I, II, IIIA+B, and IIIC disease. However, survival was considerably worse in the node-positive group compared to that in the node-negative group for each of Stage I and II disease, and was significantly worse for Stage I+II disease (P = 0.0172). The survival was significantly worse in the node-positive group compared to that in the node-negative group also for Stage I through IIIB disease taken as a whole (P = 0.0212), although not for Stage IIIA+B disease alone. On the other hand, patient survival of node-positive Stage I through IIIB disease, taken as a whole, was significantly better than that in Stage IIIC disease (P < 0.0001).
It might not be valid, on the basis of patient prognosis, to group node-positive Stage I, II, and IIIA+B disease into a criterion of Substage IIIC together with Stage III disease of abdominal implants greater than 2 cm in diameter outside the pelvis. For further evaluation of the prognostic significance of node involvement, survivals should be compared among patients with de novo node disease, with node disease removed, and otherwise similar patients without node disease, ideally in a prospective randomized trial with a large number of patients.
本研究旨在探讨（1）对于Ⅰ期、Ⅱ期、ⅢA + B期和ⅡC期疾病，淋巴结阳性组与淋巴结阴性组患者的生存率是否存在差异；（2）淋巴结阳性的Ⅰ期至ⅢB期疾病与ⅡC期疾病患者的生存率是否存在差异。
回顾性分析125例Ⅰ期、Ⅱ期和Ⅲ期上皮性卵巢癌患者的病历，分析其临床和组织学特征，特别关注淋巴结阳性或阴性状态，并比较按国际妇产科联盟（FIGO）腹腔分期的淋巴结状态患者生存率。
125例患者中有111例接受了腹膜后和腹股沟淋巴结探查，并分为淋巴结阳性组[n = 35（31.5%）]和淋巴结阴性组[n = 76（68.5%）]。与淋巴结阴性组相比，淋巴结阳性组中Ⅲ期疾病和组织学3级疾病的发生率显著更高（P = 0.0007和P = 0.0005）。对于Ⅰ期、Ⅱ期、ⅢA + B期和ⅡC期疾病中的每一期，淋巴结阳性组和淋巴结阴性组的10年生存率无显著差异。然而，对于Ⅰ期和Ⅱ期疾病中的每一期，淋巴结阳性组的生存率明显低于淋巴结阴性组，对于Ⅰ + Ⅱ期疾病，差异有统计学意义（P = 0.0172）。对于整体的Ⅰ期至ⅢB期疾病，淋巴结阳性组的生存率也明显低于淋巴结阴性组（P = 0.0212），尽管单独的ⅢA + B期疾病无此差异。另一方面，整体的淋巴结阳性的Ⅰ期至ⅢB期疾病患者的生存率明显优于ⅡC期疾病患者（P < 0.0001）。
基于患者预后，将淋巴结阳性的Ⅰ期、Ⅱ期和ⅢA + B期疾病与盆腔外直径大于2 cm的腹部种植转移的Ⅲ期疾病归为ⅡC期亚分期的标准可能无效。为了进一步评估淋巴结受累的预后意义，应比较初发有淋巴结疾病、已切除淋巴结疾病以及其他情况相似但无淋巴结疾病患者的生存率，理想情况下应进行大规模前瞻性随机试验。
