van Kol K G G, Ebisch R M F, van der Aa M, Wenzel H B, Piek J M J, Bekkers R L M
Department of Obstetrics and Gynecology and Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands; Department of Obstetrics and Gynecology GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.
Gynecol Oncol. 2023 Apr;171:9-14. doi: 10.1016/j.ygyno.2023.01.023. Epub 2023 Feb 16.
One of the major changes in the revised (2018) FIGO-staging system is the addition of stage IIIC to the previously used 2009 system. We evaluated the prognostic value of positive pelvic and/or para-aortic lymph nodes in patients with cervical cancer.
A nationwide retrospective cohort study was performed by analyzing data from the Netherlands Cancer Registry. All patients newly diagnosed with stage IB-IVA between 2005 and 2018 were identified. Three-year, 5-year and 15-year overall survival (OS) rates were estimated with the Kaplan-Meier method.
Of the included 6082 patients, 1740 patients (29%) had pelvic and/or para-aortic lymph node metastases. For patients with FIGO 2009 stage IB-IB1-IIA-IIA1 and stage IB2-IIA2-IIB with pelvic and/or para-aortic lymph node metastases the OS was significantly different (p < 0.001 and p = 0.009), with a 5-year OS of 77% and 67%, compared with 92% and 74% for women without lymph node metastases. For FIGO 2009 stage IIIA-IIIB-IVA with and without lymph node metastases, survival rates are not significantly different (p = 0.064). For FIGO 2018 stage IIIC the 3y-OS, 5y-OS and 15-year OS are 72%, 65% and 59% respectively. Survival rates of IIIC diagnosed based on imaging (IIICr) are significantly impaired compared to stage IIIC diagnosed based on pathology (IIICp) (p < 0.001).
Patients with FIGO 2009 stage IB-IIB cervical cancer with pelvic and/or para-aortic lymph node metastases have significantly impaired survival compared to patients without metastases. Survival rates of patients with FIGO 2009 stage IIIA-IVA are not affected by lymph node metastases.
修订后的（2018年）国际妇产科联盟（FIGO）分期系统的主要变化之一是在先前使用的2009年系统中增加了IIIC期。我们评估了宫颈癌患者盆腔和/或腹主动脉旁淋巴结阳性的预后价值。
通过分析荷兰癌症登记处的数据进行了一项全国性回顾性队列研究。确定了2005年至2018年间新诊断为IB-IVA期的所有患者。采用Kaplan-Meier法估计3年、5年和15年总生存率（OS）。
在纳入的6082例患者中，1740例患者（29%）有盆腔和/或腹主动脉旁淋巴结转移。对于2009年FIGO分期为IB-IB1-IIA-IIA1期以及伴有盆腔和/或腹主动脉旁淋巴结转移的IB2-IIA2-IIB期患者，其总生存率有显著差异（p < 0.001和p = 0.009），5年总生存率分别为77%和67%，而无淋巴结转移的女性为92%和74%。对于2009年FIGO分期为IIIA-IIIB-IVA期且有或无淋巴结转移的患者，生存率无显著差异（p = 0.064）。对于2018年FIGO分期IIIC期，3年总生存率、5年总生存率和15年总生存率分别为72%、65%和59%。与基于病理诊断的IIIC期（IIICp）相比，基于影像学诊断的IIIC期（IIICr）生存率显著降低（p < 0.001）。
与无转移的患者相比，2009年FIGO分期为IB-IIB期且伴有盆腔和/或腹主动脉旁淋巴结转移的宫颈癌患者生存率显著降低。2009年FIGO分期为IIIA-IVA期患者的生存率不受淋巴结转移影响。
