Tang Xuedong, Yang Baicai, Bian Wei, Li Kui, Pan Shan, Zhu Weili, Zhou Weigen, Wei Anwen, Cheng Xiaodong
Department of Gynecologic Oncology, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Gynecology, Jiaxing Women and Children's Hospital Wenzhou Medical University, Jiaxing, Zhejiang, China.
Ann Surg Oncol. 2025 May;32(5):3449-3457. doi: 10.1245/s10434-024-16802-8. Epub 2025 Jan 25.
This study aimed to explore the relationship of cervical tumor lesion location (CTLL) with bilateral parametrial involvement (PI) and pelvic lymph node metastasis (LNM).
The study retrospectively analyzed the clinicopathologic and imaging data of patients with cervical squamous cell carcinoma (SCC) retrieved from multiple centers. According to the CTLL, patients were allocated to three groups: a middle one third group, a unilaterally dominant group, and the entire-region group. Uni- and multivariate logistic regression analyses were performed to explore the preoperative risk factors related to PI and pelvic LNM. The rates of PI and pelvic LNM at the tumor-ipsilateral side and the tumor-contralateral side were compared using the Wilcoxon test.
The study enrolled 776 cases. The CTLL was an important preoperative risk factor for both PI and pelvic LNM. Parametrial involvement occurred solely on the tumor-ipsilateral side (3.57 %) in the unilaterally dominant group, whereas the rate of pelvic LNM on the tumor-ipsilateral side was 11.22 %, significantly higher than on the contralateral side (5.1 %), with no pelvic LNM found on the tumor-contralateral side of patients with tumors smaller than 3.5 cm.
Cervical SCC exhibits the characteristic of more accessible tumor-ipsilateral PI and pelvic LNM. When evaluation by magnetic resonance imaging (MRI) shows that the tumor lesion does not involve the contralateral one third of the cervix, a reduction in the resection scope of the contralateral parametrium can be considered, avoiding resection of the para-aortic lymph nodes, and if the tumor is smaller than 3.5 cm, a reduction in the resection scope of the tumor-contralateral pelvic lymph nodes also can be considered.
本研究旨在探讨宫颈肿瘤病变位置（CTLL）与双侧宫旁组织受累（PI）及盆腔淋巴结转移（LNM）之间的关系。
本研究回顾性分析了从多个中心收集的宫颈鳞状细胞癌（SCC）患者的临床病理和影像学资料。根据CTLL，将患者分为三组：中三分之一组、单侧优势组和全区域组。进行单因素和多因素逻辑回归分析，以探讨与PI和盆腔LNM相关的术前危险因素。采用Wilcoxon检验比较肿瘤同侧和对侧的PI和盆腔LNM发生率。
本研究共纳入776例病例。CTLL是PI和盆腔LNM的重要术前危险因素。在单侧优势组中，宫旁组织受累仅发生在肿瘤同侧（3.57%），而肿瘤同侧盆腔LNM发生率为11.22%，显著高于对侧（5.1%），肿瘤小于3.5 cm的患者对侧未发现盆腔LNM。
宫颈SCC表现出肿瘤同侧PI和盆腔LNM更易发生的特点。当磁共振成像（MRI）评估显示肿瘤病变未累及宫颈对侧三分之一时，可考虑缩小对侧宫旁组织的切除范围，避免切除腹主动脉旁淋巴结，若肿瘤小于3.5 cm，也可考虑缩小肿瘤对侧盆腔淋巴结的切除范围。
