Cheng Xi, Cai Shumo, Li Ziting, Tang Meiqin, Xue Muquan, Zang Rongyu
Department of Gynecologic Oncology, Cancer Hospital, Fudan University, Shanghai, 200032, PR China.
World J Surg Oncol. 2004 Dec 18;2:47. doi: 10.1186/1477-7819-2-47.
Pelvic lymph nodes metastasis is an important prognostic factor for patients with cervical carcinoma. However, the relationships between the number of positive nodes, site of metastases nodes, adjuvant therapy and the prognosis is controversial. The purpose of this study was to investigate the influence of positive lymph nodes on the prognosis of Chinese women with stage IB1-IIB cervical carcinoma.
Between January 1992 and December 1997, 398 women with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIB cervical carcinoma underwent radical surgery in Cancer Hospital, Fudan University. Of these sixty-six patients (16.6%) who were histologically confirmed to have positive pelvic lymph nodes were analyzed retrospectively. The survival was estimated using Kaplan-Meier method. The differences in survival were compared with Log-rank test. Multivariate analyses were performed with the Cox proportional hazard model.
The 5-year survival of the patients with pelvic lymph nodes metastases was 40.7%. Cox proportional hazard model analysis showed that cellular differentiation, the number of positive nodes and adjuvant therapy to be the independent prognostic factors (P < 0.05). The 5-year survival of patients with one positive node was higher than that of those with two or more positive nodes (56.5% vs. 36.4%, P < 0.05). The distant metastasis rate in the former group (5.9%) was lower than the latter's (32.7%) (P = 0.05). However, there was no significant difference of pelvic recurrence between the two groups (P > 0.05). The number of positive nodes positively correlated with the level of positive nodes (P < 0.01). The 5-year survival 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, there was no obvious difference between adjuvant radiotherapy, chemotherapy and chemo-radiotherapy (P > 0.05).
The prognosis of patients with stage IB1-IIB node-positive cervical carcinoma who underwent radical surgery alone was very poor. Adjuvant therapy increases the survival rate, decreases the pelvic recurrence and distant metastasis.
盆腔淋巴结转移是宫颈癌患者重要的预后因素。然而，阳性淋巴结数量、转移淋巴结部位、辅助治疗与预后之间的关系存在争议。本研究旨在探讨阳性淋巴结对中国IB1-IIB期宫颈癌患者预后的影响。
1992年1月至1997年12月，398例国际妇产科联盟（FIGO）IB1-IIB期宫颈癌患者在复旦大学附属肿瘤医院接受了根治性手术。对其中66例（16.6%）经组织学证实有盆腔淋巴结阳性的患者进行回顾性分析。采用Kaplan-Meier法估计生存率。生存差异采用Log-rank检验进行比较。使用Cox比例风险模型进行多因素分析。
盆腔淋巴结转移患者的5年生存率为40.7%。Cox比例风险模型分析显示，细胞分化、阳性淋巴结数量和辅助治疗是独立的预后因素（P<0.05）。有1个阳性淋巴结患者的5年生存率高于有2个或更多阳性淋巴结的患者（56.5%对36.4%，P<0.05）。前一组的远处转移率（5.9%）低于后一组（32.7%）（P=0.05）。然而，两组之间盆腔复发无显著差异（P>0.05）。阳性淋巴结数量与阳性淋巴结水平呈正相关（P<0.01）。未接受辅助治疗患者的5年生存率（12.6%）远低于接受辅助治疗患者的5年生存率（53.7%）（P<0.05）。然而，辅助放疗、化疗和放化疗之间无明显差异（P>0.05）。
单纯接受根治性手术的IB1-IIB期淋巴结阳性宫颈癌患者预后很差。辅助治疗可提高生存率，降低盆腔复发和远处转移。
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