Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
J Gynecol Oncol. 2013 Jan;24(1):29-36. doi: 10.3802/jgo.2013.24.1.29. Epub 2013 Jan 8.
The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary.
We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated.
SURGICAL STAGING YIELDED: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para-aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis.
A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.
本研究旨在评估在术前被认为局限于卵巢的卵巢癌患者中，进行腹主动脉旁淋巴结清扫至肾血管水平对准确分期的影响。
我们回顾性分析了 124 例术前认为局限于卵巢的原发性上皮性卵巢癌患者的数据，这些患者均接受了初次分期手术。研究了淋巴结转移的分布和各种淋巴结受累的危险因素。
手术分期结果：87 例（70.2%）患者为国际妇产科联合会（FIGO）Ⅰ期疾病，37 例（29.8%）患者为Ⅱ-Ⅲ期疾病：4 例ⅡA 期，6 例ⅡB 期，9 例ⅡC 期，1 例ⅢA 期和 17 例ⅢC 期。86 例患者仅行盆腔淋巴结清扫术，69 例患者行盆腔和腹主动脉旁淋巴结清扫术。69 例患者中有 17 例（24.6%）发现淋巴结转移；5 例（7.2%）患者仅盆腔淋巴结转移，8 例（11.6%）仅腹主动脉旁淋巴结转移，4 例（5.8%）盆腔和腹主动脉旁淋巴结均转移。6 例（8.7%）患者腹主动脉旁淋巴结转移位于肠系膜下动脉水平以上。多因素分析显示，肿瘤分级 3 级（p=0.01）和细胞学阳性（p=0.03）是淋巴结转移的独立预测因素。
大量术前表现为早期卵巢癌的患者存在疾病分期升级。在接受淋巴结清扫术的患者中，一些患者的腹主动脉旁淋巴结转移位于肠系膜下动脉水平以上。腹主动脉旁淋巴结清扫至肾血管水平可能会检测到隐匿性转移，并有助于制定适当的辅助治疗方案，以及提供有关预后的有用信息。
