Watanabe Toshiaki, Tamashiro Natsuki, Shimoji Yuko, Arakaki Yoshihisa, Taira Yusuke, Nakamoto Tomoko, Kudaka Wataru, Aoki Yoichi
Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Cancer Diagn Progn. 2023 Jan 3;3(1):96-101. doi: 10.21873/cdp.10185. eCollection 2023 Jan-Feb.
BACKGROUND/AIM: Pelvic lymph node (LN) metastases are found histopathologically after radical hysterectomy (RH) in some cases of cervical adenocarcinoma with no enlarged LNs on preoperatively. The aim was to clarify whether LN metastasis is a prognostic factor in these patients, and whether any postoperative therapy is advisable.
Sixty-one patients with stage I-II cervical adenocarcinoma [International Federation of Obstetrics and Gynecology (FIGO) 2008] with no enlarged pelvic LNs on preoperative imaging evaluation who underwent RH at our institution were retrospectively examined for clinicopathological, treatment, and prognosis-related factors.
The median age was 47 years. FIGO stages were IB1 in 44 patients, IB2 in 10, IIA in 4, and IIB in 3. Seventeen patients (27.9%) had positive pelvic LNs. The multivariate analysis for both overall (OS) and disease-free (DFS) survival showed only pelvic LN metastasis was an independent prognostic factor. In a multivariate analysis of LN-positive cases, multiple LN metastases was an independent prognostic factor for poorer DFS. OS rates were 100%, 83.3%, and 30.0%, and DFS rates were 85.5%, 83.3%, and 12.5% for patients with no LN metastasis, single metastasis, and multiple metastases, respectively, showing a significant difference. Eight recurrences were observed in 10 patients with multiple node-positive disease, and six (75%) had an intrapelvic recurrence.
Among patients who underwent RH for cervical adenocarcinoma with no preoperative enlarged LN and positive pelvic LNs confirmed postoperatively, multiple positive pelvic LNs are an independent poor prognostic factor. Because pelvic recurrence is common, concurrent chemoradiotherapy, possibly using paclitaxel and cisplatin, should be considered as adjuvant therapy.
背景/目的：在一些术前盆腔淋巴结未肿大的宫颈腺癌病例中，根治性子宫切除术后经组织病理学检查发现盆腔淋巴结转移。目的是明确淋巴结转移是否为这些患者的预后因素，以及术后是否建议进行任何治疗。
回顾性研究在我院接受根治性子宫切除术的61例国际妇产科联盟（FIGO）2008分期为I-II期宫颈腺癌且术前影像学评估盆腔淋巴结未肿大的患者，分析其临床病理、治疗及预后相关因素。
中位年龄为47岁。FIGO分期：IB1期44例，IB2期10例，IIA期4例，IIB期3例。17例（27.9%）患者盆腔淋巴结阳性。对总生存期（OS）和无病生存期（DFS）的多因素分析显示，只有盆腔淋巴结转移是独立的预后因素。在淋巴结阳性病例的多因素分析中，多个淋巴结转移是DFS较差的独立预后因素。无淋巴结转移、单个转移和多个转移患者的OS率分别为100%、83.3%和30.0%，DFS率分别为85.5%、83.3%和12.5%，差异有统计学意义。10例多个淋巴结阳性患者中有8例复发，6例（75%）为盆腔内复发。
对于术前盆腔淋巴结未肿大、术后证实盆腔淋巴结阳性的宫颈腺癌患者，多个盆腔淋巴结阳性是独立的不良预后因素。由于盆腔复发常见，应考虑使用紫杉醇和顺铂进行同步放化疗作为辅助治疗。
