Department of Gynecology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Int J Gynecol Cancer. 2012 Mar;22(3):490-7. doi: 10.1097/IGC.0b013e31823c369b.
We investigated the prognostic significance of multiple pelvic node metastases in cervical cancer patients who were treated with radical hysterectomy plus adjuvant chemoradiotherapy.
We retrospectively reviewed the medical records of 311 patients with International Federation of Gynecology and Obstetrics stage IB1-IIB cervical cancer who had been treated with radical hysterectomy plus adjuvant radiotherapy (RT) between January 1998 and December 2008. Of these, 119 received adjuvant RT and 192 received adjuvant concurrent chemoradiotherapy (CCRT) postoperatively. Multivariate analysis for progression-free survival (PFS) was performed using the Cox proportional hazards regression model to investigate the prognostic significance of pelvic node metastases in the 2 treatment groups. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.
Multivariate analysis demonstrated pelvic node metastasis to be an independent prognostic factor for shorter PFS in both treatment groups. When the node-positive patients were analyzed according to the number of positive pelvic nodes, we found that the patients with multiple pelvic node metastases (≥3) displayed significantly shorter PFS than those with 1 or 2 pelvic node metastases in the RT group. In contrast, in the CCRT group, the PFS of the patients with multiple pelvic node metastases (≥3) was similar to that observed of the patients with 1 or 2 pelvic node metastases.
The presence of multiple pelvic node metastases was not an independent predictor of shorter PFS in the CCRT group.
我们研究了接受根治性子宫切除术加辅助放化疗的宫颈癌患者中多个盆腔淋巴结转移的预后意义。
我们回顾性分析了 1998 年 1 月至 2008 年 12 月期间接受根治性子宫切除术加辅助放疗（RT）治疗的 311 例国际妇产科联合会（FIGO）IB1-IIB 期宫颈癌患者的病历。其中 119 例接受辅助 RT，192 例术后接受辅助同期放化疗（CCRT）。采用 Cox 比例风险回归模型对无进展生存期（PFS）进行多变量分析，以探讨 2 种治疗组中盆腔淋巴结转移的预后意义。采用 Kaplan-Meier 法计算生存率，并采用对数秩检验进行比较。
多变量分析表明，在 2 种治疗组中，盆腔淋巴结转移均是 PFS 较短的独立预后因素。当根据阳性盆腔淋巴结数量对淋巴结阳性患者进行分析时，我们发现 RT 组中存在多个盆腔淋巴结转移（≥3）的患者 PFS 明显短于存在 1 或 2 个盆腔淋巴结转移的患者。相比之下，在 CCRT 组中，存在多个盆腔淋巴结转移（≥3）的患者的 PFS 与存在 1 或 2 个盆腔淋巴结转移的患者相似。
在 CCRT 组中，多个盆腔淋巴结转移不是 PFS 较短的独立预测因素。
