Mandic A, Novakovic P, Mihajlovic O, Stojiljkovic B, Rajovic J, Davidovic M
Institute of Oncology Vojvodina, Sremska Kamenica, Serbia.
J BUON. 2008 Jan-Mar;13(1):51-4.
Advanced cervical cancer still represents a major health care challenge in the developing world. According to standard protocols the treatment of choice for stage IIB cervical cancer is cisplatin-based chemoradiotherapy. However, in some European countries, and especially in Japan, patients with stage IIB cervical cancer are generally treated with radical hysterectomy as initial treatment. The aim of this study was to compare clinical stage with pathological findings, and also to correlate any relationship between parametrial infiltration and nodal status.
From 1997 to 2006, 26 patients with FIGO stage IIB cervical cancer were radically operated (Piver class III operation). Preoperative clinical findings were compared with the pathological findings of the surgical material. The correlation between infiltration of the parametria and lymph node status was also examined. Fisher's exact test was used to examine statistical significance.
The patients' median age was 48.3 years (range 36-61). The median number of removed lymph nodes was 16 (range 8-40). The histopathological types of cervical tumors were: squamous cell carcinoma 80%, adenosquamous carcinoma 15% and adenocarcinoma 5%. In 50% of the patients the parametria were infiltrated, suggesting that 50% of the patients were clinically overstaged. Positive lymph nodes were found in 69% of patients with positive parametria and 15% in patients with negative parametria (p <0.05). Patients with positive lymph nodes received adjuvant chemoradiotherapy.
Adequate preoperative staging such as clinical examination under anesthesia or nuclear magnetic resonance could help to exclude parametrial involvement in equivocal cases. Parametrial invasion presents an important risk factor for lymph nodes metastases.
在发展中国家，晚期宫颈癌仍是主要的医疗保健挑战。根据标准方案，IIB期宫颈癌的首选治疗方法是基于顺铂的放化疗。然而，在一些欧洲国家，尤其是日本，IIB期宫颈癌患者通常以根治性子宫切除术作为初始治疗。本研究的目的是比较临床分期与病理结果，并关联宫旁浸润与淋巴结状态之间的关系。
1997年至2006年，对26例国际妇产科联盟（FIGO）IIB期宫颈癌患者进行了根治性手术（Piver III类手术）。将术前临床结果与手术标本的病理结果进行比较。还检查了宫旁浸润与淋巴结状态之间的相关性。采用Fisher精确检验来检验统计学意义。
患者的中位年龄为48.3岁（范围36 - 61岁）。切除淋巴结的中位数为16个（范围8 - 40个）。宫颈肿瘤的组织病理学类型为：鳞状细胞癌80%，腺鳞癌15%，腺癌5%。50%的患者宫旁有浸润，这表明50%的患者临床分期过高。宫旁阳性的患者中69%发现有阳性淋巴结，宫旁阴性的患者中15%有阳性淋巴结（p<0.05）。有阳性淋巴结的患者接受了辅助放化疗。
充分的术前分期，如麻醉下临床检查或核磁共振成像，有助于在可疑病例中排除宫旁受累情况。宫旁浸润是淋巴结转移的一个重要危险因素。
