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在宫颈癌根治性子宫切除术中发现阳性淋巴结时完成淋巴结清扫术的理由。

The case for completing the lymphadenectomy when positive lymph nodes are found during radical hysterectomy for cervical carcinoma.

作者信息

Kenter G G, Hellebrekers B W, Zwinderman K H, van de Vijver M, Peters L A, Trimbos J B

机构信息

Department of Gynecology, Leiden University Medical Center, The Netherlands.

出版信息

Acta Obstet Gynecol Scand. 2000 Jan;79(1):72-6.

PMID:10646820

Abstract

BACKGROUND

In the present study we report on the results of a retrospective study on the effect on survival of the pelvic lymphadenectomy in a group of 294 patients with stage Ia2-IIa cervical carcinoma treated by radical hysterectomy from 1984 through 1996 at the Leiden University Medical Center.

METHODS

Lymphadenectomy was called 'complete' when lymph node bearing tissue had been removed from 5 or 6 lymph node stations and 'not-complete' when this was the case in 1-4 stations.

RESULTS

A radical hysterectomy was carried out in 294 patients. In 63 patients positive lymph nodes were found. Patients with positive nodes showed poorer 5 year survival: 64.5% compared to 90% in patients with negative nodes. In the univariate analysis the following factors were found to affect the presence of node metastases in a statistically significant way: age, tumor size, depth of infiltration, vaso-invasion, surgical margins, parametrial infiltration, stage and place of referral. In 63 patients with positive nodes, a complete lymphadenectomy was carried out in 23 patients, and in 40 patients the procedure was incomplete. All 63 patients were treated by adjuvant radiation therapy; those with complete lymphadenectomy had significantly less recurrences (25%) compared to those with incomplete lymphadenectomy (56%): the relative risk (RR) was 2.9 (95% ci: 1.3-6.7), p=0.012. After adjustment for other prognostic factors including tumor size, depth of infiltration and parametrial involvement, the complete lymphadenectomy showed an independent effect on disease free survival: RR= 3.2 (95% ci: 1.3-7.7), p=0.011. Prognostic factors were not significantly different for patients with complete or incomplete lymphadenectomy.

CONCLUSIONS

From the results of this study, although retrospective and non randomized, it can be concluded that to complete removal of lymph nodes in combination with radical hysterectomy seems to have a beneficial effect on prognosis in case of positive nodes. The policy of aborting the procedure when lymph node metastases are found in frozen section should be questioned.

摘要

背景

在本研究中，我们报告了一项回顾性研究的结果，该研究针对1984年至1996年在莱顿大学医学中心接受根治性子宫切除术的294例Ia2-IIa期宫颈癌患者，探讨盆腔淋巴结清扫术对生存的影响。

方法

当从5或6个淋巴结站切除有淋巴结的组织时，淋巴结清扫术被称为“完整”；当从1-4个站切除时，则称为“不完整”。

结果

对294例患者实施了根治性子宫切除术。63例患者发现有阳性淋巴结。有阳性淋巴结的患者5年生存率较低：为64.5%，而阴性淋巴结患者为90%。在单因素分析中，发现以下因素对淋巴结转移的存在有统计学上的显著影响：年龄、肿瘤大小、浸润深度、血管浸润、手术切缘、宫旁浸润、分期和转诊地点。在63例有阳性淋巴结的患者中，23例进行了完整的淋巴结清扫术，40例手术不完整。所有63例患者均接受了辅助放疗；完整淋巴结清扫术的患者复发率（25%）明显低于不完整淋巴结清扫术的患者（56%）：相对风险（RR）为2.9（95%可信区间：1.3-6.7），p=0.012。在对包括肿瘤大小、浸润深度和宫旁受累等其他预后因素进行调整后，完整淋巴结清扫术对无病生存有独立影响：RR=3.2（95%可信区间：1.3-7.7），p=0.011。完整或不完整淋巴结清扫术患者的预后因素无显著差异。