早期子宫颈癌淋巴结转移34例临床观察

Clinical analysis of 34 early cervical cancer patients with pelvic nodes metastasis

目的探讨早期子宫颈癌术后淋巴结转移同步放疗、化疗与预后关系。方法回顾性分析34例早期子宫颈癌术后淋巴结转移的患者,全部行广泛性子宫切除+盆腔淋巴结清扫术。其中a期5例,b期16例,a期13例;术前放疗、化疗13例,术后全部行同步放疗、化疗;单个淋巴结转移26例,2个或2个以上淋巴结转移8例。结果淋巴结转移率22.1%(34/154),34例淋巴结转移患者全部行术后同步放疗、化疗,5年生存率82.4%。转移淋巴结直径<2cm者,5年生存率86.7%;转移性淋巴结直径≥2cm者,5年生存率57.9%;1个淋巴结转移至1级组患者,5年生存率76.6%;转移至2级组患者,5年生存率45.0%。结论淋巴结转移是影响子宫颈癌预后的重要因素,而术后对有淋巴结转移患者行同步放疗、化疗,可有效地提高5年生存率。

Objective To investigate the prognosis of patients with early cervical carcinoma undergoing synchronized chemoradiotherapy. Methods Thirty-four cervical cancer patients with positive pelvic nodes were treated by total hysterectomy plus pelvic lymph nodes dissection. Five cases were classified as Ⅰ a, 16 as Ⅰ b, 13 as Ⅱ a; and 13 cases received pre-operative radiotherapy and chemotherapy. All patients underwent synchronized chemoradiotherapy after surgery,and the clinical data were retrospectively reviewed. Results There was single lymph nodes metastasis in 26 cases,two or more lymph nodes metastasis in 8 cases. The rate of lymph nodes metastasis was 22. 1% （34/154）. The 5-year survival rate for all patients was 82.4% ; that for patients with metastatic lymph nodes 〈2 cm was 86.7% ,while that for patients with metastatic lymph nodes ≥2 cm was 57. 9%（P〈0. 039）. The 5-year survival rate of patients with lymph node metastasis to group Ⅰ was 76.6% ,while that with lymph node metastasis to group Ⅱ was 45.0% （P〈0. 048）, Conclusions Lymph node metastasis is an important prognostic factor for patients with cervical cancer. Synchronized chemoradiotherapy can significantly improve the long-term outcome of early cervical patients with lymph node metastasis.