Kim Dong Hyun, Kim Won Taek, Bae Jin Suk, Ki Yong Kan, Park Dahl, Suh Dong Soo, Kim Ki Hyung, Lee Joo Hye, Lee Ja Young, Jeon Ho Sang, Nam Ji Ho
Departments of *Radiation Oncology and †Obstetrics and Gynecology, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, Pusan National University, Busan; and ‡Department of Radiation Oncology, Yangsan Pusan National University Hospital, Yangsan, Korea.
Int J Gynecol Cancer. 2016 Sep;26(7):1274-80. doi: 10.1097/IGC.0000000000000772.
This study aimed to identify prognostic factors for para-aortic lymph node (PALN) recurrence and their effect on survival outcomes in patients with pelvic node-positive squamous cell carcinoma (SCC) of the cervix treated with definitive concurrent chemoradiotherapy (CCRT).
Of the 116 patients with biopsy-proven SCC of the uterine cervix who underwent primary CCRT from 2007 to 2012, 48 patients with pelvic LN metastasis detected by [F]-fluorodeoxyglucose positron emission tomography (FDG PET) were retrospectively analyzed. Patients with evidence of para-aortic lymphadenopathy were excluded. The whole pelvis was the standard irradiation field for all patients. The associations of age, stage, serum SCC antigen (SCC-Ag) level, maximum standardized uptake value (SUVmax), hemoglobin level, overall treatment time, adjuvant chemotherapy, and pelvic LN status with PALN recurrence and survival outcomes were evaluated.
At a median follow-up of 34.0 months (range, 8-73 months), 10 (20.8%) patients had developed PALN recurrences. The relationship between pelvic LN FDG uptake and PALN recurrence was evaluated by the cutoff value (SUVmax = 3.85) determined by receiver operating characteristic curve analysis. The independent risk factors for PALN recurrence were FDG-avid pelvic LN (SUVPLN) greater than 3.85 (hazard ratio, 13.12; P = 0.025) and posttreatment SCC-Ag level greater than 2.0 (ng/mL) (hazard ratio, 20.69; P = 0.019). Patients with an SUVPLN greater than 3.85 were found to have significantly worse 5-year distant metastasis-free (51.0% vs 79.0%, P = 0.016) and progression-free survival (38.7% vs 67.3%, P = 0.011) than those with an SUVPLN less than or equal to 3.85.
SUVPLN is a statistically significant prognostic factor of PALN recurrence and survival after definitive CCRT for pelvic node-positive SCC of the uterine cervix.
本研究旨在确定腹主动脉旁淋巴结（PALN）复发的预后因素及其对接受根治性同步放化疗（CCRT）的宫颈盆腔淋巴结阳性鳞状细胞癌（SCC）患者生存结局的影响。
回顾性分析2007年至2012年期间接受初次CCRT的116例经活检证实为子宫颈SCC患者，其中48例经[F] - 氟脱氧葡萄糖正电子发射断层扫描（FDG PET）检测到盆腔淋巴结转移。排除有腹主动脉旁淋巴结肿大证据的患者。全盆腔是所有患者的标准照射野。评估年龄、分期、血清SCC抗原（SCC - Ag）水平、最大标准化摄取值（SUVmax）、血红蛋白水平、总治疗时间、辅助化疗以及盆腔淋巴结状态与PALN复发和生存结局的相关性。
中位随访34.0个月（范围8 - 73个月），10例（20.8%）患者出现PALN复发。通过受试者工作特征曲线分析确定的临界值（SUVmax = 3.85）评估盆腔淋巴结FDG摄取与PALN复发之间的关系。PALN复发的独立危险因素为FDG摄取阳性的盆腔淋巴结（SUVPLN）大于3.85（风险比，13.12；P = 0.025）以及治疗后SCC - Ag水平大于2.0（ng/mL）（风险比，20.69；P = 0.019）。发现SUVPLN大于3.85的患者5年无远处转移生存率（51.0%对79.0%，P = 0.016）和无进展生存率（38.7%对67.3%，P = 0.011）显著低于SUVPLN小于或等于3.85的患者。
对于子宫颈盆腔淋巴结阳性SCC，在根治性CCRT后，SUVPLN是PALN复发和生存的统计学显著预后因素。
