Chen S S
Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
Gynecol Oncol. 1989 Feb;32(2):215-7. doi: 10.1016/s0090-8258(89)80035-6.
Information in the literature about the incidence of nodal spread and its clinical implication in stage I sarcoma of the uterus is limited. The purpose of this study is to provide additional information derived from surgical staging of 20 patients who were treated by primary surgery to include total abdominal hysterectomy, bilateral salpingo-oophorectomy, and selective biopsy of paraaortic and pelvic nodes. Nine out of 20 patients (45%) of this small series had lymph node metastases either to both pelvic and paraaortic nodes (6) or pelvic nodes alone (3). This high rate of nodal involvement was associated with deep myometrial invasion, uteri sounding larger than 8 cm, patients older than 65 years, and leiomyosarcoma. In 12 of 20 patients, clinical staging was an underestimate. In a follow-up from 2 to 12 years, all 9 patients with positive nodes succumbed to their diseases. This result indicates that incidence of nodal spread in stage I sarcoma of the uterus is a frequent occurrence and is related to ultimate survival. Furthermore, it suggests that lymphatic permeation might precede hematogenous spread in early sarcoma of the uterus.
关于子宫I期肉瘤淋巴结转移发生率及其临床意义的文献资料有限。本研究的目的是提供从20例接受初次手术（包括全腹子宫切除术、双侧输卵管卵巢切除术以及主动脉旁和盆腔淋巴结选择性活检）的患者手术分期中获得的更多信息。在这个小系列研究的20例患者中，有9例（45%）出现了淋巴结转移，其中6例同时转移至盆腔和主动脉旁淋巴结，3例仅转移至盆腔淋巴结。如此高的淋巴结受累率与肌层深部浸润、子宫探测长度大于8cm、年龄大于65岁以及平滑肌肉瘤有关。在20例患者中的12例中，临床分期被低估。在2至12年的随访中，所有9例淋巴结阳性患者均死于疾病。这一结果表明，子宫I期肉瘤淋巴结转移的发生率很常见，并且与最终生存率相关。此外，这表明在子宫早期肉瘤中，淋巴浸润可能先于血行转移。
