IB～IIB期宫颈癌髂总淋巴结转移高危因素及对预后的影响

Risk factors and prognosis of ⅠB-ⅡB cervical carcinoma with common iliac lymph node metastasis

背景与目的:盆腔淋巴结转移是影响宫颈癌预后的主要危险因素,有髂总淋巴结转移的患者预后更差,但目前单独对髂总淋巴结转移的系统研究少见。本研究旨在系统探讨宫颈癌髂总淋巴结转移特征、相关危险因素、治疗及预后。方法:回顾性分析了1995年1月至2005年12月中山大学肿瘤防治中心经根治术治疗的960例ⅠB～ⅡB期宫颈癌患者的髂总淋巴结转移特征、相关危险因素、治疗及预后。结果:288例患者有盆腔淋巴结转移,转移率为30.0%,其中45例有髂总淋巴结转移,转移率为4.7%。合并有髂总淋巴结转移的宫颈癌患者5年总生存率为46.1%,而合并其它盆腔淋巴结转移患者的5年总生存率为67.5%(P<0.05)。单因素分析显示,临床分期、治疗前SCC-Ag>4μg/L、宫颈浸润深度>2/3、宫旁切缘阳性与髂总淋巴结转移有关(P<0.05);盆腔淋巴结阳性组数(除髂总淋巴结)≥3组、术后复发髂总淋巴结转移患者的预后差(P<0.05);Logistic回归多因素分析显示治疗前SCC-Ag>4μg/L(P=0.026,OR=2.303)、宫旁切缘阳性(P=0.045,OR=2.634)为髂总淋巴结转移独立的危险因素。结论:合并有髂总淋巴结转移的宫颈癌患者预后较合并其它盆腔淋巴结转移的患者差;治疗前SCC-Ag>4μg/L、宫旁切缘阳性为髂总淋巴结转移独立的危险因素;盆腔淋巴结阳性组数(除髂总淋巴结)≥3组、术后复发髂总淋巴结转移患者的预后更差。

Background and Objective：Pelvic lymph node metastasis is an important prognostic factor of cervical cancer. The prognosis of cervical cancer patients with common iliac lymph node metastasis is poor,but few systematic studies have been reported. This study was to investigate the characteristics,risk,treatment and prognosis of stage IB-IIB cervical carcinoma patients with common iliac lymph node metastasis. Methods：A total of 960 patients with cervical cancer receiving radical hysterectomy and bilateral pelvic lymphadenectomy were selected from the hospitalized patients at Sun Yat-sen University Cancer Center between January 1995 and December 2005,and analyzed retrospectively. Results：Of the 960 patients,288 （30.0%） had pelvic lymph node metastasis,and 45 （4.7%） had positive common iliac lymph node. The 5-year overall survival rate （OS） of patients with common iliac lymph node metastasis was 46.1% and that of patients with other pelvic lymph node metastasis was 67.5%（ P〈0.05）. Univariate analysis showed that clinical stage,serum level of squamous cell carcinoma antigen （SCC-Ag）4 μg/L before treatment,depth of cervical invasion more than two thirds and positive parametrial margin were associated with common iliac lymph node metastasis （ P〈0.05）. Patients with ≥ 3 pelvic lymph node metastasis （excluding common iliac lymph node） or recurrence had poor prognosis （ P〈0.05）. Factors predictive of common iliac lymph node metastasis on Logistic forward regression were SCC-Ag4 μg/L （ P=0.026,OR=2.303） before treatment and positive parametrial margin （ P=0.045,OR=2.634）. Conclusions：Cervical cancer patients with common iliac lymph node metastasis had poorer prognosis compared with patients with other pelvic lymph node metastasis. SCC-Ag4 μg/L before treatment and positive parametrial margin were the independent predictive factors for common iliac lymph node metastasis of cervical carcinoma. Pelvic lymph node metastasis （excluding common iliac lymph node）≥3 or recurrence was prognostic factors for patients with common iliac lymph node metastasis.