Ayhan Ali, Gultekin Murat, Taskiran Cagatay, Celik Nilufer Yigit, Usubutun Alp, Kucukali Turkan, Yuce Kunter
Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Naci Cakir Mah. 1. Cadde, Kubra Apt. 1/1 Dikmen, Sihhiye, Ankara, Turkey.
Gynecol Oncol. 2005 May;97(2):400-4. doi: 10.1016/j.ygyno.2005.01.038.
The purpose of this study was to evaluate the prognostic factors, and the patterns of lymphatic metastasis in EOC patients who were treated with systematic pelvic and paraaortic lymphatic dissection.
A total of 420 EOC patients was retrospectively evaluated. Clinical factors available were evaluated for a possible significance in terms of lymphatic metastasis and paraaortic involvement.
Two-hundred and three patients were found to have lymphatic metastasis. In multivariable analysis, stage (P < 0.001), histology (P < 0.01 for serous; P = 0.02 for mixed, and P = 0.04, for Brenner), and Ca-125 level higher than 500 U/ml (P = 0.04) were found to be significantly related with the lymphatic involvement. Age and grade were significant factors for paraaortic metastasis both in univariable and multivariable analysis (P = 0.003 and P = 0.02, respectively). Most of the patients with unilateral tumors had contralateral pelvic and/or paraaortic metastasis. There were eleven patients with lymphatic metastasis in stage I-II disease, and five had paraaortic metastasis while an additional five patients had contralateral pelvic nodal metastasis. However, there was no lymphatic involvement in Stage IA, Grade I-II disease (0/63). Survival analysis revealed no significant difference by the number of metastatic lymph nodes.
In multivariable analysis, lymphatic involvement was predicted independently by stage, histology, and Ca-125 level. In apparently stage I-II disease, a considerable part of patients were upstaged due to lymphatic involvement. Although routine systematic lymphadenectomy is suggested for patients with early stage disease, further series are needed for a definite regimen in patients with stage IA G1-2 disease since we did not detect any lymphatic involvement in this unique group.
本研究旨在评估接受系统性盆腔及腹主动脉旁淋巴结清扫术的上皮性卵巢癌（EOC）患者的预后因素及淋巴转移模式。
对420例EOC患者进行回顾性评估。评估可获得的临床因素对淋巴转移及腹主动脉旁受累的潜在意义。
发现203例患者有淋巴转移。多变量分析显示，分期（P < 0.001）、组织学类型（浆液性P < 0.01；混合型P = 0.02；勃勒纳瘤P = 0.04）以及癌抗原125（Ca-125）水平高于500 U/ml（P = 0.04）与淋巴受累显著相关。年龄和分级在单变量及多变量分析中均是腹主动脉旁转移的显著因素（分别为P = 0.003和P = 0.02）。大多数单侧肿瘤患者有对侧盆腔和/或腹主动脉旁转移。Ⅰ-Ⅱ期疾病中有11例患者有淋巴转移，5例有腹主动脉旁转移，另有5例有对侧盆腔淋巴结转移。然而，ⅠA期、Ⅰ-Ⅱ级疾病中无淋巴受累（0/63）。生存分析显示，转移淋巴结数量对生存无显著差异。
多变量分析中，淋巴受累可由分期、组织学类型及Ca-125水平独立预测。在看似Ⅰ-Ⅱ期疾病中，相当一部分患者因淋巴受累而分期上调。尽管建议对早期疾病患者进行常规系统性淋巴结切除术，但对于ⅠA期G1-2疾病患者，由于我们在这一特殊组中未检测到任何淋巴受累，因此需要进一步的系列研究来确定明确的治疗方案。
