Sakuragi Noriaki
Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Int J Clin Oncol. 2007 Jun;12(3):165-75. doi: 10.1007/s10147-007-0661-2. Epub 2007 Jun 27.
Lymph node metastasis (LNM), together with parametrial infiltration and positive surgical margins, is an important prognostic factor in cervical cancer. The incidence of LNM increases with International Federation of Gynecology and Obstetrics (FIGO) stage, with rates being 12%-22% in stage Ib, 10%-27% in stage IIa, and 34%-43% in stage IIb. Radical hysterectomy and pelvic lymphadenectomy are widely used treatments for early-stage (Ib to IIa) cervical cancer, as well as for stage IIb disease, in some European and Asian countries. In several types of cancer, the therapeutic significance of systematic lymphadenectomy has been demonstrated by recent reports showing that a larger number of lymph nodes removed relates to better survival. In cervical cancer, a significant relationship between the number of lymph nodes removed and disease-free survival has been reported in node-positive patients. Preoperative evaluation of nodal status with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) imaging techniques is not sensitive enough to replace the histological examination of dissected nodes. The sentinel node procedure may be an alternative to systematic lymphadenectomy to reduce treatment-related morbidity, but more work on this is needed. Although the presence of LNM does not change FIGO staging, it will modulate postoperative therapy. Progression-free and overall survivals were significantly improved by the addition of chemotherapy to adjuvant radiotherapy after radical hysterectomy and lymphadenectomy. Adjuvant chemotherapy combined solely with radical hysterectomy and systematic lymphadenectomy may also provide a survival benefit. In conclusion, efforts to establish more tailored surgical strategies, by introducing advanced imaging technologies and molecular diagnostic procedures, are needed for cervical cancer.
淋巴结转移（LNM）与宫旁浸润及手术切缘阳性一样，是宫颈癌重要的预后因素。LNM的发生率随国际妇产科联盟（FIGO）分期增加而升高，Ib期为12%-22%，IIa期为10%-27%，IIb期为34%-43%。根治性子宫切除术和盆腔淋巴结清扫术是早期（Ib至IIa期）宫颈癌以及IIb期宫颈癌在一些欧洲和亚洲国家广泛应用的治疗方法。在几种癌症中，近期报告显示切除更多数量的淋巴结与更好的生存率相关，这证明了系统性淋巴结清扫术的治疗意义。在宫颈癌中，已报道在淋巴结阳性患者中切除的淋巴结数量与无病生存期之间存在显著关系。使用计算机断层扫描（CT）、磁共振成像（MRI）和正电子发射断层扫描（PET）成像技术对淋巴结状态进行术前评估，其敏感性不足以替代对切除淋巴结的组织学检查。前哨淋巴结活检术可能是系统性淋巴结清扫术的替代方法，以减少治疗相关的发病率，但对此还需要更多研究。尽管LNM的存在不改变FIGO分期，但它会调整术后治疗。根治性子宫切除术和淋巴结清扫术后，辅助放疗加用化疗可显著改善无进展生存期和总生存期。单纯辅助化疗联合根治性子宫切除术和系统性淋巴结清扫术也可能带来生存获益。总之，宫颈癌需要通过引入先进的成像技术和分子诊断程序来努力制定更具针对性的手术策略。
