评估局部晚期宫颈癌的腹膜后淋巴结状态。
Assessment of retroperitoneal lymph node status in locally advanced cervical cancer.
机构信息
Department of Gynecology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China.
Department of Pathology, Hunan Maternal and Child Health Hospital, Changsha, Hunan, China.
出版信息
BMC Cancer. 2021 May 1;21(1):484. doi: 10.1186/s12885-021-08208-6.
BACKGROUND
The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods.
METHODS
Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed.
RESULTS
The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5-1.0 cm were risk factors for CILN and/or PALN metastasis.
CONCLUSION
Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.
背景
局部晚期宫颈癌患者腹膜后淋巴结状态的评估仍然是一个问题。本研究旨在探讨这些评估方法的选择。
方法
对 96 例晚期宫颈癌患者进行腹腔镜腹膜后淋巴结清扫术。分析淋巴结转移的阳性率。比较 CT 淋巴结最小轴径（MAD）和鳞状细胞癌抗原（SCC-Ag）、及其组合预测腹膜后淋巴结转移的价值。分析髂总淋巴结（CILN）和/或主动脉旁淋巴结（PALN）转移的高危因素。
结果
淋巴结转移率为 62.50%，CILN 和/或 PALN 转移率为 31.25%。96 例患者共 172 个可见淋巴结。MAD≥1.0cm 组的淋巴结转移阳性率明显高于 0.5cm≤MAD＜1.0cm 组（83.33% vs. 26.82%）。MAD 和 SCC-Ag 确定淋巴结转移的临界值分别为 1.0cm 和 5.2ng/ml。MAD≥1.0cm 联合 SCC-Ag≥5.2ng/ml 评估淋巴结转移的准确性、特异性和 Youden 指数分别为 75.71%、100%和 0.59，明显高于 MAD≥1.0cm（72.09%、80.56%和 0.47）和 SCC-Ag≥5.2ng/ml（71.43%、68.97%和 0.42）组。相关性分析表明，非鳞状细胞癌、盆腔淋巴结（PLN）MAD≥1.0cm 加数量≥2 个和 1 个 PLN MAD≥1.0cm 伴 CILN 和/或 PALN MAD 0.5-1.0cm 是 CILN 和/或 PALN 转移的危险因素。
结论
对于 MAD≥1.0cm 和 SCC-Ag≥5.2ng/ml 的患者，以及 CILN 和/或 PALN 转移的高危因素，应行髂总血管下方淋巴结肿大切除术和 CILN/PALN 淋巴结清扫术，以降低肿瘤负荷，明确淋巴结转移状态，为后续治疗提供准确指导。对于 MAD＜1.0cm 和 SCC-Ag＜5.2ng/ml 的患者，由于淋巴结转移率较低，可直接根据影像学进行放化疗治疗。
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