淋巴结清扫术在早期上皮性卵巢癌患者中的意义。

The Significance of Lymph Node Dissection in Patients with Early Epithelial Ovarian Cancer.

机构信息

Department of Gynecology, The Third Affiliated Hospital of Wenzhou Medical University, 325200 Rui'an, Zhejiang, China.

Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, 325000 Wenzhou, Zhejiang, China.

出版信息

Ann Ital Chir. 2024;95(4):628-635. doi: 10.62713/aic.3353.

DOI:10.62713/aic.3353

PMID:39186355

Abstract

AIM

This study aimed to investigate the impact of lymph node dissection on the prognosis of early epithelial ovarian cancer and to assess the factors associated with lymph node metastasis.

METHODS

In this retrospective study, we collected and analyzed the demographic characteristics, clinical pathological data, and perioperative adverse events in newly diagnosed early epithelial ovarian cancer (EOC) patients, Federation International of Gynecology and Obstetrics (FIGO) stage IA-IIA. The patients underwent surgical treatment at the First, Second, and Third Affiliated Hospitals of Wenzhou Medical University in Zhejiang Province, China, between June 2012 and June 2022. The survival analysis was performed.

RESULTS

We enrolled 284 patients in this study, including 246 stage I, 28 stage II, and 10 stage III patients after surgery. Among them, 42 patients did not undergo lymph node dissection, 113 underwent pelvic lymph node dissection only, and 129 underwent pelvic plus para-aortic lymph node dissection. Among the lymph node dissection group, only 8 patients had lymph node metastasis (8/242, 3.3%), including 6 with pelvic lymph node metastasis and 2 with pelvic plus para-aortic lymph node metastasis. The median follow-up duration was 63 months. The systematic lymph node dissection group significantly prolonged the median operation duration and increased intraoperative blood loss and postoperative complications (p < 0.05). Postoperative multivariate Cox regression analysis revealed FIGO stage III as an independent risk factor for Progression-Free-Survival (PFS) and Overall Survival (OS) (p < 0.05). Furthermore, the preoperative cancer antigen 125 (CA125) level was observed as an independent factor affecting lymph node metastasis.

CONCLUSIONS

Systematic lymph node dissection showed minimal effect on the survival rate of patients with clinically apparent early epithelial ovarian cancer and increased the postoperative complications of patients.

摘要

目的

本研究旨在探讨淋巴结清扫对早期上皮性卵巢癌（EOC）预后的影响，并评估与淋巴结转移相关的因素。

方法

这是一项回顾性研究，我们收集并分析了 2012 年 6 月至 2022 年 6 月在中国浙江省温州医科大学第一、二、三附属医院接受手术治疗的新诊断为早期上皮性卵巢癌（FIGO 分期 IA-IIA）的患者的人口统计学特征、临床病理数据和围手术期不良事件。

结果

我们共纳入 284 例患者，其中 246 例为 I 期，28 例为 II 期，10 例为 III 期。术后 42 例患者未行淋巴结清扫术，113 例患者仅行盆腔淋巴结清扫术，129 例患者行盆腔加腹主动脉旁淋巴结清扫术。在淋巴结清扫组中，仅 8 例（8/242，3.3%）患者发生淋巴结转移，其中 6 例为盆腔淋巴结转移，2 例为盆腔加腹主动脉旁淋巴结转移。中位随访时间为 63 个月。系统淋巴结清扫组的中位手术时间显著延长，术中出血量增加，术后并发症增多（p<0.05）。多因素 Cox 回归分析显示，FIGO 分期 III 期是无进展生存（PFS）和总生存（OS）的独立危险因素（p<0.05）。此外，术前癌抗原 125（CA125）水平被观察为影响淋巴结转移的独立因素。