国际妇产科联合会（FIGO）IA2 期至 IIA 期宫颈癌中转移淋巴结的绝对数量和比值对预测术后生存的意义。
Significance of the absolute number and ratio of metastatic lymph nodes in predicting postoperative survival for the International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer.
机构信息
Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
出版信息
Int J Gynecol Cancer. 2013 Jan;23(1):157-63. doi: 10.1097/IGC.0b013e3182778bcf.
PURPOSE
This study aimed to evaluate the ratio of metastatic and removed lymph nodes (RPL) and the number of metastatic lymph nodes (MLNs) in predicting postoperative survival for International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer after radical hysterectomy and pelvic lymphadenectomy (RHPL).
METHODS
A retrospective study was conducted in which 120 patients with lymph node metastasis who underwent RHPL for cervical cancer from 2000 to 2006 was analyzed to identify the prognostic indicators by using Kaplan-Meier and Cox proportional hazard methods.
RESULTS
Of 588 patients with cervical cancer who underwent RHPL, the 5-year survival rate (YSR) of 120 with lymph node metastasis was much lower than that of 468 without lymph node metastasis (22.4% vs 84.4%, P < 0.001). By cut-point survival analysis, RPL cutoff was designed as 10%, with the 5-YSR of 42.9% and 11.8%, and MLN count cutoffs were designed as 1 and 5, with the 5-YSR of 62.5%, 20.8%, and 7.8%, respectively. With univariate analysis, increasing RPL and MLN counts were associated with a poorer survival in women with node metastasis cervical cancers. Stage, histologic grade, RPL, and MLN count were significant independent prognostic factors for survival in a multivariate Cox proportional hazard model. In addition, RPL was verified superior to MLN count in prognostic evaluation for patients with IA2 to IIA cervical cancer after RHPL because the hazard ratio of RPL (3.195) was higher than that of MLN count (1.578).
CONCLUSIONS
The RPL and MLN count may be used as the independent prognostic parameters in patients with cervical cancer with lymph node metastasis after RHPL. Comparison of the superiority of RPL and MLN count for better predicting the survival of patients with cervical cancer deserves to be investigated further.
目的
本研究旨在评估国际妇产科联合会（FIGO）分期为 IA2 至 IIA 期宫颈癌根治性子宫切除术和盆腔淋巴结清扫术后（RHPL）的转移和切除淋巴结（RPL）比率和转移淋巴结（MLN）数量对术后生存的预测作用。
方法
对 2000 年至 2006 年间接受 RHPL 治疗的 120 例淋巴结转移宫颈癌患者进行回顾性研究，采用 Kaplan-Meier 和 Cox 比例风险方法分析预后指标。
结果
在 588 例行 RHPL 的宫颈癌患者中，120 例有淋巴结转移患者的 5 年生存率（YSR）明显低于 468 例无淋巴结转移患者（22.4% vs 84.4%，P < 0.001）。通过生存分析，RPL 截断值为 10%，5 年 YSR 为 42.9%和 11.8%，MLN 计数截断值为 1 和 5，5 年 YSR 为 62.5%、20.8%和 7.8%。单因素分析显示，RPL 和 MLN 计数的增加与有淋巴结转移的宫颈癌患者生存较差相关。在多因素 Cox 比例风险模型中，分期、组织学分级、RPL 和 MLN 计数是生存的显著独立预后因素。此外，在 RHPL 治疗后 IA2 至 IIA 期宫颈癌患者中，RPL 优于 MLN 计数，因为 RPL 的风险比（3.195）高于 MLN 计数（1.578）。
结论
RPL 和 MLN 计数可作为 RHPL 后淋巴结转移宫颈癌患者的独立预后参数。比较 RPL 和 MLN 计数对预测宫颈癌患者生存的优越性值得进一步研究。
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