Tsumura N, Sakuragi N, Hareyama H, Satoh C, Oikawa M, Yamada H, Yamamoto R, Okuyama K, Fujino T, Sagawa T, Fujimoto S
Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan.
Int J Cancer. 1998 Oct 23;79(5):526-30. doi: 10.1002/(sici)1097-0215(19981023)79:5<526::aid-ijc14>3.0.co;2-#.
The distribution of lymph node metastasis and the clinicopathologic risk factors for nodal involvement in ovarian carcinoma need to be clarified based on systematic lymph node dissection. We studied 115 patients with ovarian carcinoma who underwent systematic pelvic and para-aortic lymph node dissection between 1987 and 1997. The incidence and distribution of lymph node metastasis are described and the clinico-pathologic risk factors for nodal involvement are investigated. Based on the occurrence of lymph node metastasis in the early stages, the incidence of solitary node involvement and the distribution of lymph node metastasis, we conclude that the primary site of nodal involvement in ovarian carcinoma is the para-aortic node (PAN), especially PAN superior to the inferior mesenteric artery (IMA). By univariate analysis, clinical stage, histologic type (mucinous vs. others), grade, multiple peritoneal metastases, peritoneal cytology, volume of ascites and serum CA125 level were correlated with overall incidence of lymph node metastasis. By performing a multivariate analysis with the clinical stage excluded, it was revealed that grade and peritoneal cytology were independent factors for PAN metastasis (p < 0.0025 and < 0.001, respectively) and that multiple peritoneal metastases and PAN metastasis were significant predictors of pelvic node metastasis (p < 0.01 and < 0.005, respectively). In conclusion, the PANs superior and inferior to IMA should be explored in staging of ovarian carcinoma that appears to be confined to the ovaries. To determine accurately the extent of disease, both the para-aortic and pelvic areas may need to be sampled or dissected in the case of ovarian carcinoma involving the peritoneal surfaces.
需要基于系统性淋巴结清扫来明确卵巢癌淋巴结转移的分布情况以及淋巴结受累的临床病理危险因素。我们研究了1987年至1997年间接受系统性盆腔和腹主动脉旁淋巴结清扫的115例卵巢癌患者。描述了淋巴结转移的发生率和分布情况，并对淋巴结受累的临床病理危险因素进行了研究。基于早期淋巴结转移的发生情况、孤立淋巴结受累的发生率以及淋巴结转移的分布，我们得出结论，卵巢癌淋巴结受累的主要部位是腹主动脉旁淋巴结（PAN），尤其是肠系膜下动脉（IMA）上方的腹主动脉旁淋巴结。单因素分析显示，临床分期、组织学类型（黏液性与其他类型）、分级、多发腹膜转移、腹膜细胞学检查、腹水量和血清CA125水平与淋巴结转移的总体发生率相关。在排除临床分期后进行多因素分析，结果显示分级和腹膜细胞学检查是腹主动脉旁淋巴结转移的独立因素（分别为p < 0.0025和< 0.001），多发腹膜转移和腹主动脉旁淋巴结转移是盆腔淋巴结转移的显著预测因素（分别为p < 0.01和< 0.005）。总之，对于看似局限于卵巢的卵巢癌分期，应探查肠系膜下动脉上下的腹主动脉旁淋巴结。为了准确确定疾病范围，对于累及腹膜表面的卵巢癌，可能需要对腹主动脉旁和盆腔区域进行取样或清扫。
