Horn Lars-Christian, Hentschel Bettina, Fischer Uta, Peter Dana, Bilek Karl
Institute of Pathology, Division of Breast, Gynecologic and Perinatal Pathology, University of Leipzig, Germany.
Gynecol Oncol. 2008 Nov;111(2):276-81. doi: 10.1016/j.ygyno.2008.07.017. Epub 2008 Aug 21.
Limited information exist about the frequency of micrometastases, their topographic distribution and prognostic impact in patients with cervical carcinoma (CX).
Lymph nodes of patients with surgically treated CX, FIGO IB to IIB, with pelvic lymph node involvement, were re-examined regarding the size of metastatic deposits, their topographic distribution within the pelvis. Lymph node status (pN0 vs. pN1mic=metastasis<0.2 cm vs. pN1=metastasis>0.2 cm) was correlated to recurrence free (RFS) and overall survival (OS).
31.4% of all patients (281/894) represented pelvic lymph node involvement. 22.2.% of the node positive ones showed micrometastases (pN1mic). Most commonly, obturator and internal nodes were affected by pN1mic, without any side differences. Patients with macrometastases (pN1) and micrometastases (pN1mic) represented significant reduced RFS-rate at 5-years (62% [95% CI: 54.2 to 69.8] for pN1 and 68.9% [95% CI: 55.5 to 82.4] for pN1mic) when compared to patients without metastatic disease (91.4% [95% CI: 89.0 to 93.8]; p<0.001) The 5-years OS-rate was decreased in patients with metastatic disease (pN0: 86.6% [95% CI: 83.7 to 89.5], pN1mic: 63.8% [95% CI: 50.9 to 76.7], pN1: 48.2% [95% CI: 40.4 to 56.0]; p<0.0001). These differences persisted in detailed analysis within these subgroups. In multivariate analysis, tumor stage, pelvic lymph node involvement and micrometastases were independent prognostic factors.
A remarkable number of patients with CX show micrometastases within pelvic nodes. Micrometastatic disease represents an independent prognostic factor. So, all patients with pelvic lymph node involvement, including micrometastatic deposits, might be candidates for adjuvant treatment.
关于子宫颈癌（CX）患者微转移的频率、其拓扑分布及预后影响的信息有限。
对接受手术治疗的FIGO IB至IIB期且有盆腔淋巴结受累的CX患者的淋巴结，重新检查转移灶的大小及其在盆腔内的拓扑分布。淋巴结状态（pN0对比pN1mic =转移灶<0.2 cm对比pN1 =转移灶>0.2 cm）与无复发生存期（RFS）和总生存期（OS）相关。
所有患者中有31.4%（281/894）存在盆腔淋巴结受累。淋巴结阳性患者中有22.2%显示微转移（pN1mic）。最常见的是，闭孔淋巴结和髂内淋巴结受pN1mic影响，无任何侧别差异。与无转移疾病的患者相比，有大转移灶（pN1）和微转移灶（pN1mic）的患者5年RFS率显著降低（pN1为62% [95% CI：54.2至69.8]，pN1mic为68.9% [95% CI：55.5至82.4]）（无转移疾病患者为91.4% [95% CI：89.0至93.8]；p<0.001）。有转移疾病的患者5年OS率降低（pN0：86.6% [95% CI：83.7至89.5]，pN1mic：63.8% [95% CI：50.9至76.7]，pN1：48.2% [95% CI：40.4至56.0]；p<0.0001）。这些差异在这些亚组的详细分析中持续存在。在多变量分析中，肿瘤分期、盆腔淋巴结受累和微转移是独立的预后因素。
相当数量的CX患者盆腔淋巴结内存在微转移。微转移疾病是一个独立的预后因素。因此，所有有盆腔淋巴结受累的患者，包括有微转移灶的患者，可能都是辅助治疗的候选者。
