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1.
目的:探讨宫颈癌根治术和盆腔淋巴结切除术及术后单纯化疗在有复发中危和高危因素的ⅠB~ⅡA期宫颈癌患者治疗中的效果。方法:选取在北京大学第一医院治疗的68例ⅠB~ⅡA期宫颈癌患者,初始治疗为宫颈癌根治术和盆腔淋巴结切除术,根据术后病理检查结果分为复发中危因素组(中危组)37例(侵犯宫颈深度>1/2宫颈厚度、低分化、肿瘤直径≥4cm、淋巴血管间隙受累)和复发高危因素组(高危组)31例(淋巴结转移、宫旁肿瘤侵犯、切缘阳性)。对所有患者术后辅助单纯化疗,中危组3~4个疗程,高危组4~6个疗程。宫颈鳞癌及腺鳞癌化疗为BIP方案(博来霉素+异环磷酰胺+顺铂/卡铂),腺癌化疗为TP方案(紫杉醇+顺铂/卡铂)。总结患者的3年累积无瘤生存率、复发率和手术及化疗的并发症及毒副反应。结果:37例中危组患者3年累积无瘤生存率为93.1%,31例高危组患者3年累积无瘤生存率为85.4%,两组比较,差异无统计学意义(P>0.05)。68例患者的总复发率为10.3%(7/68),中危组复发率为8.1%,高危组复发率为12.9%。中危组和高危组盆腔局部复发率分别为5.4%和6.5%。两组各项化疗毒副反应发生率比较,差异无统计学意义(P>0.05)。结论:宫颈癌手术及术后化疗对于有复发中危和高危因素的ⅠB~ⅡA期患者是一种可行的治疗选择,患者可耐受手术联合单纯化疗的并发症和毒副反应,并获得较好的近远期疗效。  相似文献   

2.
目的:探讨宫颈癌根治术和盆腔淋巴结切除术及术后单纯化疗在有复发中危和高危因素的ⅠB~ⅡA期宫颈癌患者治疗中的效果.方法:选取在北京大学第一医院治疗的68例ⅠB~ⅡA期宫颈癌患者,初始治疗为宫颈癌根治术和盆腔淋巴结切除术,根据术后病理检查结果分为复发中危因素组(中危组)37例(侵犯宫颈深度> 1/2宫颈厚度、低分化、肿瘤直径≥4 cm、淋巴血管间隙受累)和复发高危因素组(高危组)31例(淋巴结转移、宫旁肿瘤侵犯、切缘阳性).对所有患者术后辅助单纯化疗,中危组3~4个疗程,高危组4~6个疗程.宫颈鳞癌及腺鳞癌化疗为BIP方案(博来霉素+异环磷酰胺+顺铂/卡铂),腺癌化疗为TP方案(紫杉醇+顺铂/卡铂).总结患者的3年累积无瘤生存率、复发率和手术及化疗的并发症及毒副反应.结果:37例中危组患者3年累积无瘤生存率为93.1%,31例高危组患者3年累积无瘤生存率为85.4%,两组比较,差异无统计学意义(P>0.05).68例患者的总复发率为10.3% (7/68),中危组复发率为8.1%,高危组复发率为12.9%.中危组和高危组盆腔局部复发率分别为5.4%和6.5%.两组各项化疗毒副反应发生率比较,差异无统计学意义(P>0.05).结论:宫颈癌手术及术后化疗对于有复发中危和高危因素的ⅠB~ⅡA期患者是一种可行的治疗选择,患者可耐受手术联合单纯化疗的并发症和毒副反应,并获得较好的近远期疗效.  相似文献   

3.
目的:探讨宫颈癌根治术中加行腹主动脉旁淋巴结切除在Ⅰ B2及ⅡA2期宫颈癌治疗中的临床应用价值.方法:选择2006年5月至2011年7月在我院诊治的Ⅰ B2及ⅡA2期宫颈癌患者86例,分成两组.对照组45例,行宫颈癌根治术;观察组41例,宫颈癌根治术中加行腹主动脉旁淋巴结切除术;两组术后辅以放疗或放化疗.对两组术中、术后情况及复发率、生存率进行比较分析,并分析盆腔淋巴结转移、腹主动脉旁淋巴结转移与临床病理因素的关系.结果:观察组复发6例,复发率为15.0%;48个月总生存率和无瘤生存率均为70.0%.对照组复发17例,复发率为38.6%;48个月总生存率和无瘤生存率分别为68.0%和66.0%.两组比较,差异均有统计学意义(P<0.05).两组并发症发生率(29.3vs 40.0%)、术中出血量(325.0±58.0ml vs 315.0±50.1 ml)及盆腔淋巴结阳性率(56.1%vs 57.8%)比较,差异均无统计学意义(P>0.05).观察组中腹主动脉旁淋巴结阳性率为17.1%,盆腔淋巴结转移个数与腹主动脉旁淋巴结转移呈正相关(P<0.01).单因素分析表明腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P<0.05);多因素分析则表明盆腔淋巴结转移个数及腹主动脉旁淋巴结转移是影响宫颈癌患者预后的因素之一(P<0.05).结论:宫颈癌盆腔淋巴结转移个数与腹主动脉旁淋巴结转移有关.在宫颈癌根治性手术中加腹主动脉旁淋巴结切除并辅以术后治疗,可以降低复发率,提高生存率,且安全可行.  相似文献   

4.
目的探讨影响ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的临床病理高危因素。方法对2004年11月—2013年7月北京大学人民医院接受手术治疗的ⅠA~ⅡB期宫颈鳞癌296例患者的临床病理资料进行回顾性分析,探讨盆腔淋巴结转移的相关高危因素。结果 296例宫颈鳞癌患者中,ⅠA期33例,ⅠB期143例,ⅡA期61例,ⅡB期59例;平均每例切除淋巴结27个,盆腔淋巴结转移率为20.27%(60/296),其中19例因分别行左、右侧淋巴结整片切除,未能区分淋巴结部位,其余41例淋巴结转移中,闭孔淋巴结最多受累(58.54%,24/41),其次分别是髂外淋巴结(51.22%,21/41)、髂内淋巴结(31.15%,14/41)、髂总淋巴结(26.83%,11/41)和腹股沟深淋巴结(9.76%,4/41)。单因素分析显示,临床分期、病理分级、肿瘤直径、淋巴脉管间质浸润(LVSI)、宫颈间质浸润深度、子宫浸润及宫旁浸润与宫颈癌盆腔淋巴结转移密切相关(P0.05);多因素分析显示,脉管内癌栓(P=0.000)、宫颈间质浸润深度(P=0.003)及宫旁浸润(P=0.029)是影响ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。结论在ⅠA~ⅡB期宫颈鳞癌中,最易受累的淋巴结是闭孔淋巴结,其次是髂外淋巴结。LVSI、宫旁浸润及宫颈间质浸润深度是ⅠA~ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。  相似文献   

5.
目的探讨宫颈癌盆腔淋巴结转移的高危因素及对预后的影响,提高生存率。方法回顾分析1995年1月至2011年6月在首都医科大学附属北京妇产医院经根治性手术治疗550例Ⅰ~ⅡA2期宫颈癌,盆腔淋巴结转移的相关危险因素及预后。结果 64例宫颈癌有盆腔淋巴结转移,无淋巴结转移者5年生存率92.2%,有转移者5年生存率51.6%(P0.05)。单因素分析,淋巴结转移与临床分期、组织学分级、肿瘤最大径线、宫颈深间质浸润、宫旁浸润、脉管间隙浸润相关(P0.05);宫旁组织浸润、转移淋巴结部位、阴道切缘状况、转移淋巴结数量、转移淋巴结组数,是有盆腔淋巴结转移宫颈癌预后的重要因素(P0.05)。多因素分析宫颈深间质浸润(P=0.001)和脉管间隙浸润(P=0.000)是影响宫颈癌淋巴结转移的独立危险因素;转移淋巴结组数2(P=0.000)是影响有淋巴结转移宫颈癌预后的独立危险因素。结论宫颈深间质浸润、脉管间隙浸润是影响宫颈癌盆腔淋巴结转移的独立高危因素;转移淋巴结组数≥2是有淋巴结转移宫颈癌影响预后的独立危险因素。  相似文献   

6.
Ⅰ期子宫内膜癌盆腔淋巴清扫术的意义   总被引:3,自引:0,他引:3  
目的:探讨Ⅰ期子宫内膜癌患者预后的相关因素及盆腔淋巴清扫术对其预后可能的影响。方法:收集1997年8月至2005年3月浙江大学医学院附属妇产科医院临床Ⅰ期子宫内膜癌患者202例,分析影响预后的各项临床病理指标,寿命表法计算生存率,比较盆腔淋巴清扫组与平行淋巴结清扫组的复发率,并发症。结果:Ⅰ期子宫内膜癌盆腔淋巴转移率1·53%。病理类型、腹腔细胞学、盆腔淋巴转移、手术-病理分期、肌层浸润及CA125值是影响预后的独立因素。Ⅰ期低危患者,盆腔淋巴清扫术无助于提高生存率(P>0.05),其复发率也无明显差异(P>0.05),手术并发症率明显增高(P<0.05);Ⅰ期高危患者,盆腔淋巴清扫术未能延长其生存期(P>0·05),但可减少复发的例数,并发症率无明显增多(P>0.05)。结论:特殊病理类型,腹腔细胞学阳性,手术-病理分期高,盆腔淋巴转移,深肌层浸润及CA125>100U/ml的患者预后较差(P<0.05)。Ⅰ期高危子宫内膜癌患者盆腔淋巴清扫术具有一定的临床意义。  相似文献   

7.
目的:探讨年轻妇女宫颈癌的临床特征、术后复发及预后相关因素。方法:选择≤35岁行宫颈癌根治术的90例患者为研究组,同时随机选取同期35岁行宫颈癌根治术的90例患者为对照组,比较两组的临床特征及研究组中复发(46例)与未复发(44例)患者的临床病理资料,并对影响预后(5年生存率)的相关因素进行单因素和多因素分析。结果:1研究组仅阴道不规则流血比例(15.56%)高于对照组(7.78%),差异有统计学意义(P0.05),两组接触性阴道流血、白带增多、腰痛或者腹痛、无症状及病程比较,差异均无统计学意义(P0.05)。2研究组复发与未复发患者的临床病理因素比较,初治时肿瘤大小、临床分期、组织学分级、宫颈浸润深度及盆腔淋巴结转移差异有统计学意义(P0.05)。3单因素分析表明,临床分期、宫颈浸润深度和盆腔淋巴结转移是影响研究组和对照组5年生存率的共同因素。多因素分析表明,研究组患者中宫颈浸润深度、临床分期及盆腔淋巴结转移是影响预后的独立危险因素。结论:年轻宫颈癌患者的临床特征不典型。系统治疗后应对患者术后复发的高危因素进行排查和随访。对于影响预后的独立危险因素,应建立系统的防控体系,提高患者无瘤生存的时间和质量。  相似文献   

8.
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。  相似文献   

9.
目的探讨早期子宫颈神经内分泌癌(NECC)术后放疗的价值, 并分析高危病理因素对预后的影响。方法本研究为单中心回顾性队列研究, 收集2011年1月至2022年4月中国医学科学院北京协和医院收治的早期(Ⅰ~Ⅱa2期)NECC患者, 均行子宫广泛性切除术±辅助治疗, 根据术后是否放疗分为术后未放疗组和术后放疗组, 对术后复发的相关因素进行单因素及多因素logistic回归分析;采用Kaplan-Meier法计算并比较两组患者的无进展生存(PFS)时间、总生存(OS)时间、复发率和死亡率。结果 (1)共62例早期NECC患者纳入本研究, 其年龄为(43.6±11.7)岁;其中, 术后未放疗组33例、术后放疗组29例。(2)术后中位随访时间为37个月(范围:12~116个月), 随访期内23例(37%)复发, 其中7例(11%)为盆腔内复发、20例(32%)为盆腔外复发[其中4例(6%)盆腔内、外均有复发]。与未放疗组相比, 术后放疗组的盆腔内复发率(18%、3%, P=0.074)降低, 盆腔外复发率(24%、41%, P=0.150)和总复发率(33%、41%, P=0.513)均升高, ...  相似文献   

10.
目的研究淋巴结转移的Ⅰb1~Ⅱb期宫颈癌患者广泛性子宫切除加盆腔淋巴结切除术后综合治疗的方式和预后。方法选取1990年1月至2003年6月复旦大学附属肿瘤医院接受手术治疗的Ⅰb1~Ⅱb期淋巴结转移的宫颈癌患者215例。所有患者均接受了广泛性子宫切除加盆腔淋巴结切除术。根据术后治疗情况将患者分为4组:放疗加化疗组(107例)、放疗组(45例)、化疗组(22例)和无辅助治疗组(41例)。通过比较4组患者的临床病理资料,对患者预后及可能影响预后的有关因素进行分析。结果放疗加化疗组、化疗组、放疗组和无辅助治疗组患者的3年无瘤生存率分别为60.7%、53.5%、47.4%和36.0%,放疗加化疗组患者的3年无瘤生存率显著高于无辅助治疗组,两组比较,差异有统计学意义(P=0.001),而化疗组、放疗组的3年无瘤生存率分别与无辅助治疗组比较,差异无统计学意义(P值分别为0.060和0.159)。放疗加化疗组、化疗组、放疗组和无辅助治疗组患者的盆腔复发率分别为7.5%、22.7%、26.7%和34.1%,远处转移率分别为16.8%、18.2%、15.6%和22.0%,复发合并转移率分别为4.7%、0、4.4%和7.3%。放疗加化疗组盆腔复发率显著低于其余3组,与其余3组比较,差异有统计学意义(P〈0.01),而远处转移率、复发合并转移率与其余3组比较,差异无统计学意义(P〉0.05)。多因素分析显示,肿瘤直径、病理类型、淋巴结转移数目和术后辅助治疗是影响淋巴结转移的宫颈癌患者预后的重要因素(P〈0.05)。结论淋巴结转移的宫颈癌患者根治性手术后辅助放、化疗能提高3年无瘤生存率,降低盆腔复发率。  相似文献   

11.
BACKGROUND: The aim of this study was to identify the independent histopathologic prognostic factors for patients with cervical carcinoma treated with radical hysterectomy including paraaortic lymphadenectomy. METHODS: A total of 187 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy were retrospectively analyzed. The median follow-up period was 83 months. Cox regression analysis was used to select independent prognostic factors. RESULTS: Using multivariate Cox regression analysis, lymph node (LN) status (negative vs. metastasis to pelvic nodes except for common iliac nodes vs. common iliac/paraaortic node metastasis), histopathologic parametrial invasion, lymph-vascular space invasion (LVSI), and histology of pure adenocarcinoma were found to be independently related to patients' poor survival. For patients who had a tumor histologically confined to the uterus and have neither parametrial invasion nor lymph node metastasis, LVSI was the most important prognostic factor, and histologic type, depth of cervical stromal invasion, and tumor size were not related to survival. The survival of patients with a tumor extending to parametrium or pelvic lymph node(s) was adversely affected by histology of pure adenocarcinoma. When the tumor extended to common iliac or paraaortic nodes, patients' survival became quite poor irrespective of LVSI or histologic type of pure adenocarcinoma. Patients' prognosis could be stratified into low risk (patients with a tumor confined to the uterus not associated with LVSI: n = 80), intermediate risk (patients with a tumor confined to the uterus associated with positive LVSI, and patients with squamous/adenosquamous carcinoma associated with pelvic lymph node metastasis or parametrial invasion: n = 86), and high risk (patients with pure adenocarcinoma associated with pelvic lymph node metastasis or parametrial invasion, and patients with common iliac/paraaortic node metastasis: n = 21) with an estimated 5-year survival rate of 100 +/- 0 (mean +/- SE)%, 85.5 +/- 3.9%, and 25.1 +/- 9.7%, respectively. CONCLUSIONS: LN status, parametrial invasion, LVSI, and histology of pure adenocarcinoma are important histopathologic prognostic factors of cervical carcinoma treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Prognosis for patients with cervical carcinoma may be stratified by combined analysis of these histopathologic prognostic factors. Postoperative therapy needs to be individualized according to these prognostic factors and validated for its efficacy using randomized clinical trials.  相似文献   

12.
OBJECTIVES: Nodal metastasis is one of the most important prognostic factors in early stage cervical carcinoma and has an immense impact on the subsequent management. Thus, searching for nodal metastasis by pelvic lymphadenectomy is an integral part in the surgical management of cervical carcinoma. Complete nodal clearance of lymphatic tissue up to 2 cm above the bifurcation of common iliac vessels is therefore performed as a routine in our unit. The aim of this study is to investigate the incidence and pattern of pelvic lymph node metastases in patients with early stage cervical carcinoma to determine the role of common iliac node dissection in the surgery. METHODS: We retrospectively reviewed 174 operation and histopathology reports of patients who underwent pelvic lymphadenectomy because of stage IA2 to IIA cervical carcinoma. Lymph nodes collected below and above the bifurcation of common iliac vessels were labeled as pelvic nodes and common iliac nodes, respectively. The incidence and distribution of nodal metastases were analyzed. RESULTS: Complete and selective pelvic lymphadenectomy was performed in 163 and 11 patients, respectively. Nodal metastasis was documented in 35 (20.1%) patients. Pelvic and common iliac nodes were involved in 34 and 8 cases, respectively. All except one patient with common iliac node metastases were also found to have pelvic node metastasis. CONCLUSIONS: In early stage cervical carcinoma, isolated common iliac lymph node metastasis is rare, especially in cases without associated high risk factors. Less extensive pelvic lymphadenectomy may be considered in these patients in order to reduce operation morbidity and time.  相似文献   

13.
Chen L  Lü WG  Xie X  Chen HZ  Yu H  Ni XH 《中华妇产科杂志》2005,40(4):239-242
目的分析子宫颈鳞癌Ⅰb~Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用。方法回顾性分析接受手术治疗的306例Ⅰb~Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析。结果306例患者的5年生存率为78 1%。单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0 05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0 05)。根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90 3%、83 9%和43 1%。低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2 2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13 5%,远处转移的发生率为1 3%, 局部复发合并远处转移的发生率为0 6%;高危组(淋巴结转移或合并其他危险因素)局部复发和远处转移的发生率分别为25 9%和48 3%,局部复发合并远处转移的发生率为10 3%。结论淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb~Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗。  相似文献   

14.
盆腔淋巴清扫术对子宫内膜癌预后的影响   总被引:9,自引:0,他引:9  
目的 探讨子宫内膜癌盆腔淋巴转移的相关因素及盆腔淋巴清扫术对子宫内膜癌预后的影响。方法 选择 1981年 1月至 2 0 0 2年 12月行子宫内膜癌盆腔淋巴清扫术患者 90例 ,淋巴结取样活检术患者 12例 ,分析这 10 2例患者淋巴转移与各临床病理指标的关系。随机选取同期未行淋巴清扫术的 90例患者作为对照与行淋巴清扫术的 90例患者进行比较 ,寿命表法计算两者的生存率。结果  10 2例患者中 ,低分化、深肌层浸润、宫颈浸润、腹腔冲洗液细胞学检查阳性、附件浸润、远处转移者 ,盆腔淋巴转移的发生率升高 ,分别为 46%、42 %、44%、52 %、75%、10 0 %。盆腔淋巴转移患者的 5年累计生存率 (3 7% )低于无淋巴转移者 (89% ,P <0 0 1)。 90例行盆腔淋巴清扫术患者与对照者的 5年累计生存率分别为 78%和 72 % ,两者比较 ,差异无显著性 (P >0 0 5)。COX逐步回归分析显示 ,盆腔淋巴清扫术不是影响患者预后的独立因素。结论 低分化、深肌层浸润、宫颈浸润、腹腔冲洗液细胞学检查阳性、附件浸润、远处转移是子宫内膜癌盆腔淋巴转移的高危因素 ,有盆腔淋巴转移的患者预后差 ,但盆腔淋巴清扫术并不改善患者预后  相似文献   

15.
目的 探讨子宫内膜癌淋巴结转移的特征及对预后的影响.方法 回顾性分析2000年7月至2008年2月间于北京大学人民医院妇科接受手术治疗并行淋巴结切除术的227例子宫内膜癌患者的临床病理资料.结果 (1)淋巴结转移的特征:227例患者均行盆腔淋巴结切除术,22例(9.7%)有盆腔淋巴结转移;此22例患者中20例进行盆腔淋巴结分组,12例有多组盆腔淋巴结转移,最常见的淋巴结转移部位为髂外淋巴结(12/20);138例患者同时行腹主动脉旁淋巴结切除术,6例(4.4%)有腹主动脉旁淋巴结转移,其中5例合并盆腔淋巴结转移.(2)淋巴结转移的影响因素分析:不同年龄、宫颈和附件受累情况、肌层浸润深度、病理分级、ER表达的患者间盆腔淋巴结转移率比较,差异均有统计学意义(P<0.05);而不同病理类型和PR表达的患者间盆腔淋巴结转移率比较,差异均无统计学意义(P>0.05).上述不同因素的患者间腹主动脉旁淋巴结转移率比较,差异均无统计学意义(P>0.05).(3)淋巴结转移患者的预后:有、无盆腔淋巴结转移患者的3年无瘤生存率分别为(81.8±8.2)%和(97.4 4±1.2)%,两者比较,差异有统计学意义(P=0.004);有、无腹主动脉旁淋巴结转移患者的3年无瘤生存率分别为100%和(96.7 4±1.6)%,两者比较,差异无统计学意义(P>0.05).(4)子宫内膜癌患者复发的影响因素分析:单因素分析显示,患者年龄>50岁、附件受累、盆腔淋巴结转移患者的复发率明显升高(P<0.01);而宫颈受累、肌层浸润深度、腹主动脉旁淋巴结转移、病理类型、病理分级情况与复发无关(P>0.05).Cox回归法分析显示,附件受累和患者年龄是影响患者复发的独立危险因素(P=0.011,P=0.025).结论 子宫内膜癌盆腔淋巴结转移最常见于髂外淋巴结,腹主动脉旁淋巴结转移常合并有盆腔淋巴结转移.宫颈、附件受累及深肌层浸润、病理分级高、ER阴性的患者较易发生盆腔淋巴结转移,有盆腔淋巴结转移患者的预后较差.
Abstract:
Objective To explore the lymph nodes (LN) metastasis characters of the endometrial carcinoma and its relation with the patients' prognosis. Methods A retrospective study was carried out on 227 cases of endometrial carcinoma who admitted to our department and underwent LN excision from Jul. 2000 to Feb. 2008. Results Among 227 cases who underwent pelvic LN excision, there were 22 cases (9.7%) presented LN metastasis. There were 12 cases with positive external iliac LN from 20 cases of patients with data in LN grouping. Para-aortic LN excision was carried out on 138 patients. There were 6 cases with positive para-aortic LN, 5 cases of them together with pelvic LN metastasis. Those patients with cervix involvement, annex metastasis, deep myometrium infiltration, grade 2-3 and negative estrogen receptor occurred pelvic LN metastasis more frequently than the others ( P < 0. 05 ). Among the 6 cases with positive para-aortic LN, there were 3 cases ( 3/6) with deep myometrium infiltration. For those whose paraaortic LN was negative, it was only 16. 7% (22 cases). But there were no difference statistically between them ( P> 0. 05 ). There were significant difference in 3 years disease-free survival rate between patients with positive pelvic LN or negative pelvic LN [(81. 8 ± 8. 2)% vs ( 97. 4 ± 1. 2 ) % , P = 0. 004]. While there were not significant difference in 3 years disease-free survival rate between patients with positive para-aortic LN or negative para-aortic LN [100% vs ( 96. 7 ± 1. 6) % , P > 0. 05]. Single factor analysis showed that the age more than 50 years, annex metastasis and pelvic LN metastasis related with the recurrence (P <0. 01). But cervix involvement, deep myometrium infiltration, para-aortic LN metastasis, pathology type, tumor grade and estrogen receptor did not relate with the recurrence ( P > 0. 05 ). Cox regression analysis showed that annex metastasis and the age of patients were independent risk factors affecting the recurrence ( P = 0. 011, P = 0. 025 ). Conclusions The most common site of pelvic LN metastasis is the external iliac LN for endometrial carcinoma patients. The patients with positive para-aortic LN always accompanied pelvic LN metastasis. Those patients with cervical involvement, annex metastasis, deep myometrium infiltration, poor differentiation and negative estrogen receptor be more likely exist pelvic LN metastasis. Pelvic LN metastasis may affect the prognosis of endometrial carcinoma patients.  相似文献   

16.
目的 探讨治疗前血清鳞状细胞癌抗原(SCCAg)滴度与宫颈鳞状细胞癌(鳞癌)临床病理特征的关系,以及作为预测预后的因素的意义。方法 选择114例治疗前检测过血清SCCAg并经治疗后长期随访的Ⅰb1~Ⅱa期宫颈鳞癌患者,结合临床资料对SCCAg与临床病理特征及预后的关系进行单因素和多因素分析。结果 单因素分析显示,治疗前血清SCCAg滴度升高(正常值≤1.5mg/L)与肿瘤直径、深肌层浸润及盆腔淋巴结转移相关(P〈0.05);多因素分析显示,SCCAg滴度升高与深肌层浸润(P=0.029)、盆腔淋巴结转移(P=0.049)相关。114例患者的5年累积无瘤生存率为78.6%,总复发率为27.2%。单因素分析显示,SCCAg滴度升高、盆腔淋巴结转移与5年累积无瘤生存率及复发相关(P〈0.05);多因素分析显示,影响预后的独立因素为SCCAg滴度升高(P=0.030)和盆腔淋巴结转移(P=0.003),影响复发的显著相关因素为盆腔淋巴结转移(P=0.006)。盆腔淋巴结转移且SCCAg滴度正常者与盆腔淋巴结转移且SCCAg滴度升高者,5年累积无瘤生存率(分别为50.0%、50.9%)、复发率[分别为60.0%(6/10)、47.1%(8/17)]、局部复发率[分别为3/8、20.0%(3/15)]和远处复发率[分别为1/8、20.0%(3/15)]分别比较,差异均无统计学意义(P〉0.05)。盆腔淋巴结无转移且SCCAg滴度正常者与盆腔淋巴结无转移且SCCAg滴度升高者,5年累积无瘤生存率(分别为98.0%、71.8%,P=0.003)、复发率[分别为9.8%(5/51)、33.3%(12/36),P=0.006]、局部复发率[分别为2.1%(1/47)、26.5%(9/34),P=0.001]分别比较,差异均有统计学意义。结论 治疗前血清SCCAg滴度升高和盆腔淋巴结转移是影响Ⅰb1~Ⅱa期宫颈鳞癌患者预后的独立因素。治疗前血清SCCAg滴度升高且盆腔淋巴结无转移患者的局部复发风险显著升高。  相似文献   

17.
No results from therapeutic trials describing the best therapeutic procedure for cervical carcinoma in stages I and IIa are available. Analysis of a series of 242 cases of cervical carcinoma in stages I and IIa, from 1975 to 1980, treated with radical surgery and radiation therapy, yields a therapeutic approach that envisions the most reliable evaluation of subclinical extension, cure of cervical tumor and prevention of pelvic or extra-pelvic metastases with a minimum of post-radiation problems. The choice of combination surgery and radiation therapy is primarily determined by staging and the volume of the central pelvic tumor. For stages I and IIb (upper third of vagina involved) with central pelvic tumor less than 4 cm in diameter, the usual procedure is recommended i.e. radium application, total hysterectomy with pelvic lymphadenectomy followed by external irradiation of pelvic lymphatics in cases with lymphadenopathy. For stages IIb (obvious parametrial involvement) and for stages I or II with central pelvic tumor between 4 and 6 cm in diameter: total dose external and internal pelvic radiation therapy followed by total hysterectomy without pelvic lymphadenectomy but with exploration of obturator, hypogastric, external iliac, common iliac, and aortic nodes. For the rare supravaginal central pelvic tumors greater than 6 cm in diameter, the risk of clinical evaluative error and incomplete sterility by irradiation alone, warrants first an explorative laparotomy using Wertheim's procedure, then pelvic lymphadenectomy and exploration of pelvic and aortic lymph nodes.  相似文献   

18.

Objective

To identify clinicopathological risk factors for pelvic lymph node metastasis, and to evaluate the clinical validity of these factors in selecting patients who need pelvic lymph node dissection.

Methods

The data of 466 patients who had lymphadenectomy for endometrioid adenocarcinoma of the endometrium between January 2002 and December 2010 were reviewed retrospectively.

Results

All patients underwent pelvic lymphadenectomy and 192 (41.2%) patients also underwent paraaortic lymphadenectomy. The median number of pelvic lymph node was 16 (range: 2-46) and of paraaortic lymph node was 5 (range: 2-16). 10.1% (47/466) of all patients had pelvic lymph node involvement and 7.8% (15/192) of the patients had paraaortic lymph node involvement (LNI). Pelvic LNI was significantly more common in the presence of higher grades of tumor, LVSI, deep myometrial invasion, positive peritoneal cytology and cervical involvement. The logistic regression analysis revealed that LVSI, cervical glandular invasion and cervical stromal invasion remained to be the independent risk factors for LNI. When the LVSI and/or cervical involvement were considered as high risk for pelvic lymph node metastasis, NPV and specificity were found to be 96.3% and 68.4%, respectively. LNI was correctly estimated in 323 women (69%), overestimated in 132 women (28%) and underestimated in 11 women (2%).

Conclusion

LVSI, cervical glandular and stromal involvement were independent risk factors for pelvic LNI. These variables can be assessed pre- or intraoperatively with a high rate of accuracy, the model which uses these variables may be successfully used in the prediction of pelvic lymph node metastasis.  相似文献   

19.
OBJECTIVE: The goal of this study was to identify risk factors in patients with node-positive stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy with pelvic lymph node dissection and postoperative irradiation. METHODS: Two hundred forty-two patients with FIGO stage IB, IIA, and IIB cervical carcinoma underwent radical hysterectomy with pelvic lymph node dissection; pathological analysis of the surgical specimen showed positive lymph nodes in 59 patients. These 59 patients were further treated with postoperative radiotherapy. Eighteen patients were in stage IB, 4 in stage IIA, and 37 in stage IIB. Histological tumor type, tumor size, lymph-vascular space invasion, parametrium infiltration, number of positive nodes, and involvement of common iliac nodes were assessed for correlation with cancer recurrence. RESULTS: When all these variables were assessed in the Cox proportional regression analysis, parametrium infiltration (P = 0. 0199) and number of positive nodes (two or more nodes) (P = 0.0483) revealed the factor correlating significantly with disease-specific survival. Based on these two factors, node-positive patients could be divided into low-risk (n = 11), intermediate-risk (n = 29), and high-risk (n = 19) groups. The 5-year disease-specific survival for the low-risk group was 100% which was significantly better than the 39.1% for the high-risk group (P = 0.0012). CONCLUSION: For patients in the high-risk group, it may be worthwhile to consider new strategies to improve survival.  相似文献   

20.
PURPOSE: To determine the accuracy of (18)FDG PET in identifying sites of metastatic disease prior to pelvic exenteration or radical resection in patients (pts) with recurrent cervical or vaginal cancers. METHODS: Pts with recurrent cervical or vaginal cancer being evaluated for surgical resection were enrolled in a prospective study approved by the institutional human subjects review board. All patients underwent (18)FDG PET scans as well as CT and/or MRI scans and were required to have pathologic confirmation of any sites suggestive of tumor recurrence. RESULTS: Between 1998 and 2002 a total of 27 pts were enrolled on the study. Seven patients did not complete all study requirements and are excluded from further analysis. All pts had undergone prior pelvic radiation therapy and five patients had also received chemotherapy. CT/MRI scans identified three patients with possible metastatic disease in the following sites: (1) iliac nodes (2 pts) and (2) lungs (1 pt). After surgical and pathological evaluation, only one of these sites, the lungs, was confirmed to have metastatic disease. PET scans identified possible metastatic disease in nine patients and included the following sites: (1) pelvic nodes (4 pts), (2) para-aortic nodes (2 pts), (3) axillary node (1 pt), (4) bowel wall (1 pt) and (5) lungs (1 pt). After surgical and pathologic evaluation metastatic disease was identified in five of these pts at the following sites: iliac nodes, 2; para-aortic nodes, 1; bowel wall, 1; and lungs, 1. Of the sites identified by PET scan as areas of metastasis CT scan only identified the pulmonary metastasis. CONCLUSION: (18)FDG PET was found to have a sensitivity of 100% and a specificity of 73% in detecting sites of extra-pelvic metastasis and may be the most accurate test to determine eligibility for pelvic exenteration.  相似文献   

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