新辅助化疗及术前加术后放疗后 IB2-IVA 期宫颈癌患者术后标本的组织病理学结果

Histopathological findings in postoperative specimens in cervical cancer patients with stages IB2-IVA after neoadjuvant chemotherapy and preoperative plus postoperative radiotherapy.

作者信息

Kornovski Y, Gorchev G

机构信息

Medical University-Varna, St. Anna Hospital, Clinic of Gynecology, Varna, Bulgaria.

出版信息

J BUON. 2007 Jan-Mar;12(1):57-63.

PMID:17436403

Abstract

PURPOSE

To determine the incidence of the histopathological findings indicative for risk of recurrence in patients with locally advanced cervical cancer (LACC) who were treated with neoadjuvant chemotherapy (NCT) and radiation therapy (RT) before operation.

PATIENTS AND METHODS

Sixty-three patients were included: 45 patients (group 1) underwent external beam RT and then surgical treatment followed by postoperative RT, and 18 (group 2) patients were treated with NCT and surgery followed by postoperative RT. Surgery was class III-V radical hysterectomy with pelvic lymph node dissection (LND), and paraaortic LND at indication. NCT included 2-3 courses of cisplatin, ifosfamide and bleomycin administered at 3-week intervals. In group 1 FIGO stage IIB prevailed (n=29, 64.4%). Forty-four (97.8%) patients had squamous cell carcinoma and 1 (5.6%) adenosquamous carcinoma. In group 2 stage IIB also prevailed (n=13, 72.2%), whereas all 18 (100%) patients had squamous cell carcinoma. The average age in group 1 and 2 was 48.8 years (range 31-69) and 46.3 years (range 32-64), respectively.

RESULTS

In group 1 lymph node metastases (LNM) were found in 35.56% of the cases, macroscopically detectable LNM in 15.6%, LNM above the common iliac artery level in 11.1%, multiple LNM (>3 LNM) in 17.8%, parametrial invasion in 4.4%, deep stromal invasion in 31.1%, lymphovascular space invasion (LVSI) in 13.3%, infiltration of canalis cervicalis in 15.6%, infiltration of isthmus uteri in 8.9% and ovarian metastases in 4.4%. In group 2 LNM were found in 38.89% of the patients, macroscopically detectable metastases in 22%, multiple (>3 LNM) LNM in 17%, LNM above the common iliac artery level in 22%, deep stromal invasion in 47%, parametrial infiltration in 24%, LVSI in 12%, tumor infiltration in canalis cervicalis in 12%, and ovarian metastases in 6%.

CONCLUSION

NCT followed by surgical treatment and RT leads to postoperative histological results that are not worse than the standard preoperative RT approach.

摘要

目的

确定术前接受新辅助化疗（NCT）和放射治疗（RT）的局部晚期宫颈癌（LACC）患者中提示复发风险的组织病理学发现的发生率。

患者与方法

纳入63例患者：45例患者（第1组）接受体外放疗，然后进行手术治疗，术后再行放疗；18例（第2组）患者接受NCT和手术，术后再行放疗。手术为III - V级根治性子宫切除术及盆腔淋巴结清扫术（LND），必要时行腹主动脉旁LND。NCT包括每3周给予2 - 3个疗程的顺铂、异环磷酰胺和博来霉素。第1组中FIGO IIB期占多数（n = 29，64.4%）。44例（97.8%）患者为鳞状细胞癌，1例（2.2%）为腺鳞癌。第2组中IIB期也占多数（n = 13，72.2%），而所有18例（100%）患者均为鳞状细胞癌。第1组和第2组的平均年龄分别为48.8岁（范围31 - 69岁）和46.3岁（范围32 - 64岁）。

结果

第1组中，35.56%的病例发现有淋巴结转移（LNM），15.6%为肉眼可检测到的LNM，11.1%为髂总动脉水平以上的LNM，17.8%为多发LNM（>3个LNM），4.4%为宫旁浸润，31.1%为深层间质浸润，13.3%为脉管间隙浸润（LVSI），15.6%为宫颈管浸润，8.9%为子宫峡部浸润，4.4%为卵巢转移。第2组中，38.89%的患者发现有LNM，22%为肉眼可检测到的转移灶，17%为多发（>3个LNM）LNM，22%为髂总动脉水平以上的LNM，47%为深层间质浸润，24%为宫旁浸润，12%为LVSI，12%为宫颈管肿瘤浸润，6%为卵巢转移。