浸润性宫颈癌治疗后淋巴道转移的临床分析

Lymphatic Metastasis in Patients with Invasive Cervical Carcinoma after Initial Treatment

背景与目的:淋巴道转移是宫颈癌治疗后的主要复发方式。本研究探讨浸润性宫颈癌治疗后出现淋巴道转移的特点、治疗及预后。方法:回顾性分析1990～2000年间浙江省肿瘤医院收治的123例治疗后出现淋巴转移的浸润性宫颈癌患者,初治以单纯手术治疗5例,手术辅以放射治疗45例,单纯放射治疗73例。所有患者接受了以局部放疗和/或全身化疗为主的挽救性治疗。结果:治疗后出现淋巴转移的部位依次为锁骨上淋巴结95例(77.2%),腹主动脉旁淋巴结62例(50.4%),腹股沟淋巴结12例(9.8%),腋窝淋巴结3例(2.4%)。首次治疗至出现淋巴转移的中位时间间隔为14个月,间隔≤6个月及>6个月的患者分别为36例及87例。本组总的3年生存率为15.0%,5年生存率为1.5%。单纯淋巴结转移者76例,淋巴结转移伴血道转移和/或盆腔复发者47例,3年生存率分别为23.1%和4.7%。多因素分析显示,首次治疗至出现转移的时间间隔及有无伴随血道转移和/或盆腔复发为预后因素。结论:宫颈癌治疗后出现单纯淋巴道转移者再治疗可获得较好的疗效。

BACKGROUND ＆ OBJECTIVE： Lymphatic metastasis is the major recurrent way in invasive cervical carcinoma. This study was to summarize the characteristics, treatment, and prognosis of lymphatic metastasis in invasive cervical carcinoma patients after initial treatment. METHODS： Clinical data of 123 invasive cervical carcinoma patients with lymphatic metastasis after initial treatment at Zhejiang Provincial Cancer Hospital between 1990 and 2000 were analyzed. Of the 123 patients, 5 received operation alone, 45 received operation and adjuvant radiotherapy, and 73 received radiotherapy alone. All patients received salvage treatment of local radiotherapy and/or chemotherapy. RESULTS, Of the 123 patients, 95 （77.2%） had supraclavicular lymph node metastasis, 62 （50.4%） had para-aortic lymph node metastasis, 12 （9.8%） had inguinal lymph node metastasis, and 3 （2.4%） had axillary lymph node metastasis. The median duration from initial treatment to lymphatic metastasis was 14 months. Of the 123 patients, 36 developed metastasis within 6 months after initial treatment and 87 developed metastasis more than 6 months later. The 3- and 5-year overall survival rates were 15.0% and 1.5%. The 3-year survival rates were 23.1% for the 76 patients with lymphatic metastasis alone, and 4.7% for the 47 patients with both lymphatic metastasis and pelvic recurrence or hematogenous metastasis. Multivariate analysis revealed that the duration from initial treatment to lymphatic metastasis and concomitance of hematogenous metastasis and/or pelvic recurrence were significant prognostic factors of invasive cervical carcinoma. CONCLUSION： Invasive cervical carcinoma patients with lymphatic metastasis alone after initial treatment may benefit from aggressive salvage treatment.