Ushijima Kimio
Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Int J Clin Oncol. 2007 Jun;12(3):181-6. doi: 10.1007/s10147-007-0672-z. Epub 2007 Jun 27.
The mechanisms and clinical significance of lymph node involvement in ovarian cancer have been revealed since the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new clinical staging including retroperitoneal lymph node status. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. As a surgical approach, systemic lymphadenectomy is necessary to obtain accurate clinical stage, and it has obvious diagnostic value. Nevertheless, a recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes. Other factors, such as chemosensitivity, histological grade, and the size of residuals have also influenced survival in ovarian cancer. From the viewpoint of adverse effects and survival benefit, the efficacy of lymphadenectomy remains controversial. Therefore, further accumulation of clinical data is needed to establish the indications for lymph node dissection; when this procedure is done, it should be performed by experienced gynecologic oncologists at selected institutions.
自国际妇产科联盟（FIGO）引入包括腹膜后淋巴结状态的新临床分期以来，卵巢癌淋巴结受累的机制及临床意义已被揭示。卵巢癌淋巴引流途径具有多方向性已得到公认。淋巴结受累的发生率及模式取决于疾病进展程度和组织学类型。因此，很难将单个淋巴结指定为前哨淋巴结。作为一种手术方式，系统性淋巴结清扫对于准确获得临床分期是必要的，且具有明显的诊断价值。然而，最近一项针对晚期卵巢癌患者的大型随机试验表明，与仅切除肉眼可见的淋巴结相比，系统性淋巴结清扫对生存率并无影响。其他因素，如化疗敏感性、组织学分级和残留灶大小等，也对卵巢癌的生存率产生影响。从不良反应和生存获益的角度来看，淋巴结清扫的疗效仍存在争议。因此，需要进一步积累临床数据以确立淋巴结清扫的指征；当进行该手术时，应由选定机构中经验丰富的妇科肿瘤学家来实施。
