早期宫颈癌中意外淋巴引流途径的预测因素。
Predictive factors of unexpected lymphatic drainage pathways in early-stage cervical cancer.
机构信息
Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, Paris, France; URDIA Anatomy EA 4465 UFR Biomédicale des Saints-Pères, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France.
Gynecology Department, University Hospital, University of Lausanne, Lausanne, Switzerland.
出版信息
Gynecol Oncol. 2019 Jul;154(1):102-109. doi: 10.1016/j.ygyno.2019.04.008. Epub 2019 Apr 16.
OBJECTIVES
The purpose of this study was to describe sentinel lymph nodes (SLN) topography in patients with early-stage cervical cancer and to determine factors associated with atypical lymphatic drainage pathway (LDP).
METHODS
We analyzed the data of two prospective multicentric trials on SLN biopsy for cervical cancer (SENTICOL I and II) in women undergoing surgery for early-stage cervical cancer. SLN detection was realized with a combined labeling technique (Patent blue and radioactive tracer). Patients having bilateral SLN detection were included. Univariate and Multivariate analysis were performed by patients and by side to assess clinical and pathologic factors that may predict atypical LDP.
RESULTS
Between January 2005 and July 2012, 326 patients with 1104 intraoperative detected SLNs fulfilled the inclusion criteria. The SLNs were mainly located in the interiliac or external iliac area in 83.2%. The other localizations were: 9.2% in the common iliac area, 3.9% in the parametrium, 1.6% in the promontory area, 1.5% in the paraaortic area and 0.5% in other areas. Thirty-five patients (10.7%) had atypical SLN without SLN in typical area on one or both sides. In multivariate analysis, tumor size ≥20 mm appeared as an independent factor of having at least one exclusive atypical LDP (ORa = 3.95 95%CI = [1.60-9.78], p = 0.003). Multiparity decreased significantly the probability of having at least one exclusive atypical LDP (ORa = 0.16 95%CI = [0.07-0.39], p < 0.0001).
CONCLUSIONS
Tumor size larger than 20 mm and nulliparity increase the risk of having exclusive atypical LDP in early-stage cervical cancer.
目的
本研究旨在描述早期宫颈癌患者前哨淋巴结（SLN）的分布，并确定与非典型淋巴引流途径（LDP）相关的因素。
方法
我们分析了两项关于早期宫颈癌 SLN 活检的前瞻性多中心试验（SENTICOL I 和 II）的数据，这些患者均因早期宫颈癌而行手术治疗。使用联合标记技术（专利蓝和放射性示踪剂）进行 SLN 检测。我们纳入了双侧 SLN 检测的患者。通过患者和侧别进行单变量和多变量分析，评估可能预测非典型 LDP 的临床和病理因素。
结果
2005 年 1 月至 2012 年 7 月，326 例 1104 例术中检测到的 SLN 符合纳入标准。SLN 主要位于骼内或骼外区域，占 83.2%。其他定位为：骼总区 9.2%、宫旁组织 3.9%、穹窿区 1.6%、腹主动脉旁区 1.5%和其他区域 0.5%。35 例（10.7%）患者单侧或双侧至少存在一个非典型 SLN，而无典型区域的 SLN。多变量分析显示，肿瘤直径≥20mm 是出现至少一条非典型 LDP 的独立因素（ORa=3.95，95%CI[1.60-9.78]，p=0.003）。多产显著降低了至少存在一条非典型 LDP 的概率（ORa=0.16，95%CI[0.07-0.39]，p<0.0001）。
结论
肿瘤直径大于 20mm 和无多产史增加了早期宫颈癌患者出现非典型 LDP 的风险。
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