宫颈癌根治性放疗后腹主动脉旁淋巴结复发

Para-aortic lymph node recurrence after curative radiotherapy for cervical cancer.

作者信息

Cho Won Kyung, Kim Young Im, Park Won, Yang Kyungmi, Kim Haeyoung, Cha Hyejung

机构信息

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea.

Department of Obstetrics and Gynecology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.

出版信息

Int J Gynecol Cancer. 2019 Sep;29(7):1116-1120. doi: 10.1136/ijgc-2019-000615.

DOI:10.1136/ijgc-2019-000615

PMID:31474588

Abstract

OBJECTIVE

The para-aortic lymph nodes are one of the most common sites in recurrent cervical cancer. However, treatment strategies for para-aortic lymph node recurrence have not yet been established.This study aimed to evaluate the prognostic factors and treatment outcomes in patients with para-aortic lymph node recurrence after curative radiotherapy for cervical cancer.

METHODS

We retrospectively reviewed patients who developed para-aortic lymph node recurrence following curative radiation therapy for cervical cancer from January 2001 and December 2014 at the Samsung Medical Center. Prognostic factors for overall survival after recurrence were analyzed by univariate and multivariate analyses.

RESULTS

A total of 67 patients were included in the analysis. After a median follow-up of 24.0 months (range 4-155), the 3-year overall survival rate was 42.7%. 32 patients had isolated para-aortic lymph node recurrence (group 1), 21 patients had para-aortic lymph node recurrence combined with other lymph node recurrence (group 2), and 14 patients developed para-aortic lymph node recurrence with distant organ metastasis (group 3). The 3-year overall survival rates in groups 1, 2, and 3 were 60.8%, 42.1%, and 7.7%, respectively (p<0.001). In multivariate analysis, histologic type of squamous cell carcinoma (p=0.028), non-symptomatic recurrence (p=0.024), isolated para-aortic lymph node recurrence (p=0.008), and disease-free interval (p=0.008) were significant factors for survival. Among the patients with isolated para-aortic lymph node recurrence, survival rates differed significantly according to disease-free interval; the 3-year overall survival in patients with disease-free interval ≥12 months and disease-free interval <12 months was 69.6% and 37.5%, respectively (p<0.001).

CONCLUSIONS

In patients with para-aortic lymph node recurrence from cervical cancer, histologic type, presence of symptoms, extent of disease, and disease-free interval were the prognostic factors for survival. Patients with isolated para-aortic lymph node recurrence with disease-free interval ≥12 months had higher survival outcomes at 3 years.

摘要

目的

主动脉旁淋巴结是复发性宫颈癌最常见的部位之一。然而，主动脉旁淋巴结复发的治疗策略尚未确立。本研究旨在评估宫颈癌根治性放疗后发生主动脉旁淋巴结复发患者的预后因素及治疗结果。

方法

我们回顾性分析了2001年1月至2014年12月在三星医疗中心接受宫颈癌根治性放疗后发生主动脉旁淋巴结复发的患者。通过单因素和多因素分析来分析复发后总生存的预后因素。

结果

共有67例患者纳入分析。中位随访24.0个月（范围4 - 155个月）后，3年总生存率为42.7%。32例患者为孤立性主动脉旁淋巴结复发（第1组），21例患者为主动脉旁淋巴结复发合并其他淋巴结复发（第2组），14例患者发生主动脉旁淋巴结复发并伴有远处器官转移（第3组）。第1、2和3组的3年总生存率分别为60.8%、42.1%和7.7%（p<0.001）。多因素分析中，鳞状细胞癌组织学类型（p = 0.028）、无症状复发（p = 0.024）、孤立性主动脉旁淋巴结复发（p = 0.008）和无病间期（p = 0.008）是生存的显著因素。在孤立性主动脉旁淋巴结复发的患者中，根据无病间期生存率有显著差异；无病间期≥12个月和无病间期<12个月的患者3年总生存率分别为69.6%和37.5%（p<0.001）。