Togami Shinichi, Kamio Masaki, Yanazume Shintaro, Yoshinaga Mitsuhiro, Douchi Tsutomu
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Int J Gynecol Cancer. 2014 Jul;24(6):1072-6. doi: 10.1097/IGC.0000000000000163.
The aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.
A total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.
The incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P < 0.0001). Univariate analysis revealed that parametrial invasion (P < 0.0001), tumor markers (P = 0.0006), tumor size greater than 2 cm (P < 0.0001), tumor size less than 3 cm (P = 0.0009), and tumor size greater than 4 cm (P = 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P = 0.01; odds ratio, 3.37; 95% confidence interval, 1.31-9.0) and tumor size greater than 2 cm (P = 0.005; odds ratio, 4.93; 95% confidence interval, 1.54-22.01) were independently associated with nodal metastasis.
Pelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.
本研究旨在术前预测子宫颈癌盆腔淋巴结转移情况并评估省略盆腔淋巴结清扫术的潜在疗效。
共有163例国际妇产科联盟（FIGO）分期为IA2至IIB期的浸润性子宫颈癌患者参与本研究，所有患者均接受了根治性子宫切除术及盆腔淋巴结清扫术。
IA2期、IB1期、IB2期、IIA期和IIB期子宫颈癌的盆腔淋巴结转移发生率分别为0%（0/12）、17%（13/76）、22%（6/27）、33%（8/24）和63%（15/24）。观察到淋巴结转移状态对总生存期有显著差异（P<0.0001）。单因素分析显示，宫旁组织浸润（P<0.0001）、肿瘤标志物（P = 0.0006）、肿瘤大小大于2 cm（P<0.0001）、肿瘤大小小于3 cm（P = 0.0009）以及肿瘤大小大于4 cm（P = 0.0024）与盆腔淋巴结转移相关。然而，多因素分析显示，宫旁组织浸润（P = 0.01；比值比，3.37；95%置信区间，1.31 - 9.0）和肿瘤大小大于2 cm（P = 0.005；比值比，4.93；95%置信区间，1.54 - 22.01）与淋巴结转移独立相关。
对于宫旁组织浸润阴性且肿瘤大小小于2 cm的患者，可避免进行盆腔淋巴结清扫术，从而将术后并发症降至最低。
