腹膜后淋巴清扫术对原发性输卵管癌生存预后的影响

The survival effect of systematic lymphadenectomy in primary fallopian tube cancer:an analysis of 67 cases

目的探讨腹膜后淋巴清扫术在原发性输卵管癌(PFTC)治疗中的作用。方法回顾性分析天津医科大学总医院与天津市中心妇产科医院1995年1月至2008年6月收治的临床资料完整PFTC病例67例,分析腹膜后淋巴清扫术对生存预后的影响并探讨影响PFTC预后的相关因素。结果早期(Ⅰ期和Ⅱ期)患者行腹膜后淋巴清扫者的总生存期(OS)和无进展生存期(PFS)均好于未行腹膜后淋巴清扫者(P=0.020,P=0.025),而晚期患者无论是否行腹膜后淋巴清扫术其OS与PFS差异无统计学意义(P=0.574,P=0.810)。淋巴结阳性患者的OS与PFS均短于阴性者(P<0.001,P<0.001)。临床分期、腹膜后淋巴结转移、术后残余病灶是PFTC生存预后的独立因素(P=0.021,P=0.038,P=0.031)。结论早期PFTC应行包括腹膜后淋巴清扫术在内的全面分期手术,使患者获得准确的手术分期及恰当的术后辅助治疗;晚期病例采取肿瘤细胞减灭术,尽量缩小残余病灶,以延长患者生存期。

Objective To evaluate the value of systematic lymphadeneetomy （SL） in the treatment of primary fallopian tube cancer （PFFC）. Method Retrospectively analyze 67 cases of PFTC who were treated in Tianjin Medical University General Hospital and Tianjin Central Hospital of O＆G between Jan. 1995 and Jun. 2008. The survival value of SL and the prognostic factors were studied. Results In the early -stage （stage I and II ） patients, the overall survival （OS） and progress free survival （PFS） were longer in the group with SL than without SL （P = 0. 020, P = 0. 025 ）. However, there was no significant difference of OS and PFS between the patients with and without SL in the advanced disease. The OS and PFS were better in cases with negative lymph node than that with positive lymph node（ P 〈 0. 001 ）. Stage, metastasis of retroperitoneal lymph node, and residual disease were the independent prognosis factors of PFTC （ P = 0. 021, P = 0. 038, P = 0.031 ）. Conclusion Staging operation including SL should be done in early - stage PFTC, so as to achieve the accurate staging and following treatment. In advanced cases, the debulking surgery to reduce residual disease as much as possible is critical to survival.