Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
University Clinic for Medical Radiation Physics, Medical Campus Pius-Hospital, Carl von Ossietzky University Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany.
Radiat Oncol. 2021 Mar 20;16(1):54. doi: 10.1186/s13014-021-01781-x.
Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment.
A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification.
Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases.
The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.
对于 IB1 期宫颈癌患者，推荐进行系统性盆腔淋巴结清扫术或全盆腔照射。然而，宫颈癌淋巴肿瘤扩散的确切模式尚不清楚。在本研究中，我们评估了 IB1 期宫颈癌淋巴结转移的分布，以探索为患者量身定制治疗方案的可能性。
回顾性分析了 2014 年 10 月至 2017 年 12 月期间 289 名根据 2009 年 FIGO 分期为 IB1 期的宫颈癌患者。所有患者均接受腹腔镜根治性子宫切除术（Querleu 和 Morrow 型 C2）和系统性盆腔淋巴结清扫术，伴或不伴腹主动脉旁淋巴结清扫术（根据 Querleu 和 Morrow 为 2 级或 3 级）。从 7 个明确的解剖部位和其他组织中取出的淋巴结进行组织病理学检查，并根据 WHO/IARC 分类进行分型、分级和分期。
共分析了 8314 个淋巴结，平均每个患者 31.88±10.34 个淋巴结。44 例（15.22%）患者存在淋巴结转移。淋巴扩散到不同解剖部位的发生率从 0%（骶前）到 30.92%（闭孔淋巴结）不等。肿瘤直径大于 2cm、组织学证实的脉管间隙浸润（LVSI）和宫旁侵犯与更高的淋巴转移风险显著相关，而肥胖（BMI≥25）与淋巴转移独立负相关。
IB1 期宫颈癌患者的淋巴结转移发生率低，但具有预后意义。对于肿瘤较小、肥胖且缺乏宫旁侵犯或 LVSI 的低危患者，可以考虑个体化治疗。
