组织学证实的盆腔和腹主动脉旁淋巴结转移的发生率以及局部晚期宫颈癌患者的分期上调率：一项前瞻性随机试验的结果

Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial.

作者信息

Tsunoda Audrey Tieko, Marnitz Simone, Soares Nunes Joao, Mattos de Cunha Andrade Carlos Eduardo, Scapulatempo Neto Christovam, Blohmer Jens-Uwe, Herrmann Jörg, Kerr Ligia Maria, Martus Peter, Schneider Achim, Favero Giovanni, Köhler Christhardt

机构信息

Gynecologic Oncology Department, Hospital Erasto Gaertner and Instituto de Oncologia do Paraná, Curitiba, Brazil.

出版信息

Oncology. 2017;92(4):213-220. doi: 10.1159/000453666. Epub 2017 Feb 1.

DOI:10.1159/000453666

PMID:28142146

Abstract

BACKGROUND

Surgical staging is associated with a significant rate of upstaging compared to clinical/radiological staging in patients with locally advanced cervical cancer.

OBJECTIVE

To analyze the stage-specific percentage of pelvic and para-aortic lymph node metastases and the upstaging ratio in a prospective randomized trial (Uterus-11).

METHODS

FIGO stage IIB-IVA cervical cancer patients were randomized to surgical staging (arm A) or to clinical staging and primary chemoradiation (arm B). Arm B patients underwent CT-guided biopsy of suspicious para-aortic lymph nodes. Confirmed para-aortic metastasis patients received extended-field radiation therapy.

RESULTS

A total of 234 patients were enrolled, including 120 (arm A) and 114 (arm B) treated per protocol. The groups were well balanced. Pelvic and para-aortic lymph node metastases were identified after surgical staging in 51 and 24% of patients, respectively (p < 0.001). Pelvic and para-aortic lymph node metastases were confirmed in 45 and 20% of IIB patients and in 71 and 37% of IIIB patients, respectively. Upstaging occurred in 39/120 (33%) in arm A and in 9/114 (8%) in arm B (p < 0.001).

CONCLUSION

The histological results in both groups led to a considerable rate of upstaging. Oncological data from the Uterus-11 study may reveal whether modified therapy translates into a survival benefit.

摘要

背景

与局部晚期宫颈癌患者的临床/放射学分期相比，手术分期的分期上调率显著。

目的

分析一项前瞻性随机试验（子宫-11）中盆腔和腹主动脉旁淋巴结转移的分期特异性百分比及分期上调率。

方法

国际妇产科联盟（FIGO）IIB-IVA期宫颈癌患者被随机分为手术分期组（A组）或临床分期及初始放化疗组（B组）。B组患者接受CT引导下可疑腹主动脉旁淋巴结活检。确诊为腹主动脉旁转移的患者接受扩大野放射治疗。

结果

共纳入234例患者，其中按方案治疗的A组120例，B组114例。两组均衡性良好。手术分期后分别有51%和24%的患者发现盆腔和腹主动脉旁淋巴结转移（p<0.001）。IIB期患者中分别有45%和20%、IIIB期患者中分别有71%和37%确诊为盆腔和腹主动脉旁淋巴结转移。A组39/120（33%）、B组9/114（8%）出现分期上调（p<0.001）。