摘要
目的探讨宫颈癌伴盆腔淋巴结转移患者的复发规律及预后影响因素。方法选取1994年1月至2001年12月间中山大学肿瘤防治中心收治的按国际妇产科联盟（FIGO）的标准其临床分期为Ⅰb1～Ⅱa期的宫颈癌伴盆腔淋巴结转移的患者共124例，结合临床病理资料对其复发及预后情况进行回顾性分析。结果患者的5年总生存率和5年无瘤生存率分别为63．3％、61．4％；总复发率为39．5％（49／124），其中复发部位明确的41例患者（盆腔内、盆腔外和盆腔内外同时复发患者分别为25、13和3例）中盆腔内复发率（61．0％，25／41）显著高于盆腔外复发率（31．7％，13／41；P=0．008）。多因素分析显示，髂总淋巴结转移是影响患者预后的独立的危险因素（P=0．035）。根据这一因素，将盆腔淋巴结转移的患者分为低危组（髂总淋巴结无转移，104例）和高危组（髂总淋巴结转移，20例），其5年无瘤生存率分别为69．4％和24．5％，两组比较，差异有统计学意义（P=0．003）；低危组盆腔内复发率为22．1％（23／104），高危组为25．0％（5／20），两组比较，差异无统计学意义（P〉0．05）；低危组盆腔外复发率为7．7％（8／104），高危组为40．0％（8／20），两组比较，差异有统计学意义（P〈0．01）。结论伴盆腔淋巴结转移的宫颈癌患者以盆腔内复发为主，而其中髂总淋巴结转移者以盆腔外复发为主。髂总淋巴结转移是影响宫颈癌患者预后的独立的危险因素。
Objective To investigate the pattern of disease relapse and prognostic risk factor of patients with cervical carcinoma and pelvic lymph node metastasis. Methods A total of 124 cases of International Federation of Gynecology and Obstetrics （FIGO） Ⅰ b1 - Ⅱ a cervical carcinoma with pelvic node metastasis who were treated at the Cancer Center of Sun Yat-sen University during January 1994 to December 2001 were selected for this study. Prognosis and recurrence were retrospectively analyzed using the clinico-pathological data. Results The overall 5 year survival and 5 year disease-free survival were 63.3% and 61.4% , respectively. Overall recurrence rate was 39. 5% （49/124） , among which intra-pelvic relapse （61.0% ,25/41 ） was significantly more common than extra-pelvic relapse （ 31.7% , 13/41 ; P = 0. 008 ）. Multivariate analysis identified involvement of common iliac node as an independent prognostic factor （ P = 0. 035）. According to this factor, node-positive patients could be divided into low risk group （without common iliac node involvement, 104 cases ） and high risk group （with common iliac node involvement, 20 cases）. The 5 year disease-free survival were 69. 4% and 24. 5% respectively, with a significant difference （P = 0. 003）. Intra-pelvic relapse was observed in 22. 1% （23/104）of low risk and 25.0% （5/20） of high risk group respectively, with no significant difference （P 〉 0. 05 ）. However extra-pelvic relapse was seen in 7. 7% （ 8/104 ） of low risk and 40. 0% （ 8/20 ） of high risk group, with a significant difference （P 〈 0. 01 ）. Conclusions Common iliac node involvement is a significant factor influencing the prognosis of patients with cervical carcinoma and pelvic lymph node metastasis. Patients with positive common iliac nodes have significantly decreased 5 year disease-free survival and higher extra-pelvlc disease recurrence rates compared with those whose common iliac nodes are negative. These findings provide important data for design of individualized treatment mode.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2008年第6期425-428,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
宫颈肿瘤
淋巴转移
肿瘤复发
局部
预后
Cervix neoplasms
Lymphatic metastasis
Neoplasm recurrence,local
Prognosis
