ⅠB1～ⅡB期宫颈癌盆腔淋巴结转移的分布特点及其对预后的影响

Pelvic Lymph Node Metastases in FIGOⅠB1～ⅡB Cervical Carcinoma:Distribution and Impact on Prognosis

目的:探索FIGO分期ⅠB1～ⅡB期宫颈癌盆腔转移淋巴结在各个解剖分区的分布特点及不同类型淋巴转移对预后的影响。方法:回顾性分析手术治疗FIGOⅠB1～ⅡB期宫颈癌331例患者的临床资料,评价盆腔淋巴结转移情况、在各分区的分布频度及与各临床病理因素的相关性,分析淋巴结转移部位、数目对预后的影响。结果:总的盆腔淋巴结转移率为26.9%(89/331),转移淋巴结242枚,67.8%(164/242)分布于宫旁/闭孔区。淋巴结转移与FIGO分期和深肌层浸润相关(r为0.242和0.403,P均=0.000)。331例患者5年总生存率(5-yOS)为87.0%,低位转移组5-yOS(76.1%)略优于高位转移组(58.2%),差异无统计学意义(P=0.065);单个淋巴结转移组5-yOS(80.4%)略优于多个淋巴结转移组(68.3%),差异无统计学意义(P=0.153)。影响宫颈癌预后的独立因素为FIGO分期、淋巴结转移、病理类型(P值分别为0.007、0.000、0.001)。结论:宫颈癌淋巴结转移与FIGO分期和深肌层浸润有关;宫旁/闭孔区淋巴结最易受累;淋巴转移是预后的独立因素;高位、多个淋巴结转移是否是预后的不利因素,尚需扩大样本进一步研究。

Objective：To explore the topographic distribution of metastatic pelvic lymph nodes and impacts of different types of metastases on prognosis in patients with cervical carcinoma staged ⅠB1-ⅡB. Meth- ods： Clinical data of 331 patients with cervical carcinoma staged ⅠB1-ⅡB treated with surgery were retro- spectively studied. The incidence of metastatic pelvic lymph nodes, their distribution in each anatomic area, and their correlation with other clinic-pathologic factors, anatomic distribution of the metastatic lymph nodes and their impact on prognosis were analyzed. Results ：26.9% patients had pelvic lymph node metastases. A- mong 242 metastatic lymph nodes,67.8% of them were located in parametrial/obturator region. Lymph node metastasis was significantly correlated with FIGO stage and deep muscle infiltration（ r was 0. 242 and 0. 403 re- spectively, P =0. 000）. 5-year overall survival was 87. 0% in this series,among which survival status of the low site metastasis group（76. 1% ） and single lymph node involved group（58. 2% ） were slightly better than that of the high site metastasis group（80.4%） and multiple lymph node involved group（68.3% ） ,and no statistic significance was found in these differences （ P = 0. 065 and 0. 153, respectively）, respectively. Independent related factors for the prognosis of the cervical carcinoma were FIGO stage, lymph node involvement, and histological types according to Cox regression （P =0. 007,0. 000,0. 001, respectively）. Conclusions： Lymph node metastasis is correlated with FIGO stage and deep muscle infiltration. Parametrial/obturator lymph nodes are most vulnerable to lymphatic metastasis anatomically. Lymph node metastasis is an important in- dependent related factor for prognosis of cervical carcinoma. Further researches with larger sample are nee- ded to verified whether high site and multiple lymph node involvement are adverse factors for prognosis.