Wright Jason D, Grigsby Perry W, Brooks Rebecca, Powell Matthew A, Gibb Randall K, Gao Feng, Rader Janet S, Mutch David G
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Cancer. 2007 Sep 15;110(6):1281-6. doi: 10.1002/cncr.22899.
Removal of the parametrial soft tissue is recommended for patients with cervical cancer undergoing radical hysterectomy. Parametrectomy results in significant morbidity. The objective of the study was to determine factors predictive of parametrial tumor spread and to define a subset of patients at low risk for parametrial disease.
Patients with invasive cervical cancer who underwent radical hysterectomy from 1989-2005 were examined. Analysis was performed to determine factors associated with parametrial tumor spread. Survival estimates were determined using the Kaplan-Meier method.
A total of 594 patients were identified. Parametrial metastases were documented in 64 (10.8%). Factors associated with parametrial disease were: histology, advanced grade, deep cervical invasion, lymphovascular space invasion (LVSI), large tumor size, advanced stage, uterine or vaginal involvement, and pelvic or para-aortic lymph node metastases (P < .0001 for each). Parametrial metastases were associated with increased risk of recurrence and decreased disease-free and overall survivals (P < .0001). A subgroup analysis was performed to identify patients at low risk for parametrial spread. In pelvic node-negative women parametrial disease was noted in 6.0% (30/498) compared with 47.9% (34 of 71) of those with positive pelvic nodes (P < .0001). If further stratified to women with negative nodes, no LVSI, and tumors < 2 cm, the incidence of parametrial disease was only 0.4%.
Parametrial spread is a strong predictor of recurrence and decreased survival. Parametrial invasion is rare in patients with small tumors, no LVSI, and negative pelvic nodes (no poor prognostic factors). Further study is warranted to determine the feasibility of omitting parametrectomy in these low-risk patients.
对于接受根治性子宫切除术的宫颈癌患者，推荐切除宫旁软组织。宫旁切除术会导致明显的发病率。本研究的目的是确定预测宫旁肿瘤扩散的因素，并定义一组宫旁疾病低风险患者。
对1989年至2005年接受根治性子宫切除术的浸润性宫颈癌患者进行检查。进行分析以确定与宫旁肿瘤扩散相关的因素。使用Kaplan-Meier方法确定生存估计值。
共确定了594例患者。64例（10.8%）记录有宫旁转移。与宫旁疾病相关的因素有：组织学类型、高级别、宫颈深层浸润、淋巴管间隙浸润（LVSI）、肿瘤体积大、晚期、子宫或阴道受累以及盆腔或腹主动脉旁淋巴结转移（每项P <.0001）。宫旁转移与复发风险增加以及无病生存期和总生存期降低相关（P <.0001）。进行亚组分析以确定宫旁扩散低风险患者。盆腔淋巴结阴性的女性中，6.0%（30/498）有宫旁疾病，而盆腔淋巴结阳性的女性中这一比例为47.9%（71例中的34例）（P <.0001）。如果进一步分层为淋巴结阴性、无LVSI且肿瘤<2 cm的女性，宫旁疾病的发生率仅为0.4%。
宫旁扩散是复发和生存期降低的有力预测指标。在肿瘤小、无LVSI且盆腔淋巴结阴性（无不良预后因素）的患者中，宫旁浸润很少见。有必要进一步研究以确定在这些低风险患者中省略宫旁切除术的可行性。
