Department of Gynecology-Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie Paris 6, 4 rue de la Chine, Paris 75020, France.
Br J Cancer. 2012 Jan 3;106(1):39-44. doi: 10.1038/bjc.2011.541. Epub 2011 Dec 6.
Detection of lymph node involvement in women with IB2-IIB cervical cancer could have a positive effect on survival. We set out to evaluate the incidence of pelvic and/or para-aortic lymph node involvement using the sentinel node (SN) biopsy and its impact on survival.
From 2002 to 2010, 66 women with IB2-IIB cervical cancer underwent a pelvic and paraaortic lymphadenectomy with SN biopsy. Survival between groups according to lymph node status was evaluated.
Mean tumour size was 43.5 mm. At least one SN was detected in 69% of the 45 SN procedures performed. Sixteen of these patients had metastatic SN and the false negative rate was 20%. Metastatic pelvic SNs or non-SNs were detected in 33 patients (50%), including pelvic-positive nodes in 26 (40%), pelvic- and paraaortic-positive lymph nodes in seven (11%), and paraaortic skip metastases in two (6%). Positive paraaortic node was the sole determinant for disease-free survival (DFS) and overall survival (OS; P<0.001). Differences in DFS and OS between groups according to the nodal status were observed (P<0.001).
SN procedure gave a higher rate of metastasis detection. Further studies are required to evaluate whether pre-therapeutic node staging, including paraaortic and pelvic lymphanedectomy, should be performed.
检测 IB2-IIB 期宫颈癌患者的淋巴结转移情况可能对生存有积极影响。我们旨在评估前哨淋巴结 (SN) 活检对盆腔和/或腹主动脉旁淋巴结受累的发生率及其对生存的影响。
2002 年至 2010 年，66 例 IB2-IIB 期宫颈癌患者接受了盆腔和腹主动脉旁淋巴结清扫术和 SN 活检。根据淋巴结状态评估各组之间的生存情况。
平均肿瘤大小为 43.5mm。在 45 例 SN 手术中，有 69%至少检测到一个 SN。在这 16 例患者中，有 16 例 SN 转移，假阴性率为 20%。33 例患者（50%）检测到转移性盆腔 SN 或非 SN，包括 26 例（40%）盆腔阳性淋巴结、7 例（11%）盆腔和腹主动脉阳性淋巴结和 2 例（6%）腹主动脉跳跃性转移。阳性腹主动脉旁淋巴结是无病生存 (DFS) 和总生存 (OS) 的唯一决定因素 (P<0.001)。根据淋巴结状态，DFS 和 OS 差异有统计学意义 (P<0.001)。
SN 操作提高了转移的检出率。需要进一步研究评估是否应进行包括腹主动脉旁和盆腔淋巴结清扫术在内的术前淋巴结分期。
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