Fregnani José Humberto Tavares Guerreiro, Soares Fernando Augusto, Novik Pablo Roberto, Lopes Ademar, Latorre Maria do Rosário Dias de Oliveira
Centro de Tratamento e Pesquisa, Hospital do Câncer A. C. Camargo.
Rev Assoc Med Bras (1992). 2007 Jul-Aug;53(4):338-43. doi: 10.1590/s0104-42302007000400020.
To investigate the variables associated with pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA.
The study was carried out with 289 patients with invasive carcinoma of the uterine cervix (IB and IIA) who underwent radical surgery, admitted to the Gynecology Department of the Treatment and Research Center of the Hospital do Câncer A. C. Camargo, between 1980 and 1999. Data were collected from patient's records and from review of the histological sections from the uterine cervices and the lymph nodes, including sociodemographic data (age at diagnosis, skin color), clinical data (disease stage, preoperative hemoglobin level, body mass index) and histopathological data (histological type, histological grade, blood and/or lymphatic capillary embolization, perineural invasion, depth of tumor invasion into cervical stroma, intensity of inflammatory reaction in the uterine cervix, tumor necrosis, tumor size, invasion of the lateral cervical ligaments and uterine body, and lymph node status). Associations between lymph node metastasis and the different variables were evaluated by means of the chi-square test, Fisher's exact test and multiple logistic regression.
Pelvic lymph node metastasis was found in 65 patients (22.5%). The following risk factors for lymph node metastasis were identified by multivariate analysis: hemoglobin level <10.0 g% (OR = 3.6; 95% CI: 1.210.7), tumor invasion of the middle third (OR = 3.3; 95% CI: 1.110.7) and deep third of the uterine cervix (OR = 5.4; 95% CI: 1.717.3), absent or slight inflammatory reaction in the uterine cervix (OR = 2.4; 95% CI: 1.15.2) and keratinizing squamous cell carcinoma (OR = 3.3; 95% CI: 1.47.6).
This study identified four risk factors for pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA. Of these, three are not usually described in literature as predictive variables for lymph node metastasis (preoperative anemia, absent or slight inflammatory reaction and keratinizing of squamous cell carcinoma).
探讨IB期和IIA期子宫颈癌患者盆腔淋巴结转移相关变量。
本研究对1980年至1999年间收治于A.C.卡马戈癌症医院治疗与研究中心妇科、接受根治性手术的289例浸润性子宫颈癌（IB期和IIA期）患者进行。数据收集自患者病历以及子宫颈和淋巴结组织切片复查，包括社会人口统计学数据（诊断时年龄、肤色）、临床数据（疾病分期、术前血红蛋白水平、体重指数）和组织病理学数据（组织学类型、组织学分级、血液和/或淋巴管栓塞、神经周围浸润、肿瘤浸润子宫颈间质深度、子宫颈炎症反应强度、肿瘤坏死、肿瘤大小、宫颈旁韧带和子宫体浸润情况以及淋巴结状态）。通过卡方检验、Fisher精确检验和多因素逻辑回归评估淋巴结转移与不同变量之间的关联。
65例患者（22.5%）发现盆腔淋巴结转移。多因素分析确定以下淋巴结转移危险因素：血红蛋白水平<10.0 g%（比值比[OR]=3.6；95%置信区间[CI]：1.210.7）、肿瘤浸润子宫颈中三分之一（OR = 3.3；95% CI：1.110.7）和深三分之一（OR = 5.4；95% CI：1.717.3）、子宫颈无或轻度炎症反应（OR = 2.4；95% CI：1.15.2）以及角化型鳞状细胞癌（OR = 3.3；95% CI：1.4~7.6）。
本研究确定了IB期和IIA期子宫颈癌患者盆腔淋巴结转移的四个危险因素。其中，三个危险因素在文献中通常未被描述为淋巴结转移的预测变量（术前贫血、无或轻度炎症反应以及鳞状细胞癌角化）。
