盆腔淋巴结HPV-DNA检出率与早期宫颈癌临床转移的关系

目的 探讨早期宫颈癌患者盆腔淋巴结HPV-DNA检出与组织病理学确定的淋巴结转移之间的关系.方法 采用HPV通用引物PCR直接测序法扩增31例官颈癌原发部位肿瘤组织及盆腔淋巴结组织HPV-DNA L1区基因序列,分析淋巴结组织中HPV阳性率与临床病理特征之间的关系.结果 31例盆腔淋巴结中HPV-DNA检出率为58.1％.13例组织病理学确认有淋巴结转移的组织中HPV-DNA检出率为84.6％.18例组织病理学检查无淋巴结转移的盆腔淋巴结 HPV-DNA检出率为27.8％.盆腔淋巴结组织病理学确认转移与HPV-DNA检出有关.组织病理学检查和HPV-DNA检测均提示阳性淋巴结中闭孔、髂内、髂外这三组淋巴结占90％以上.结论 盆腔淋巴结HPV-DNA检出阳性是一个有意义的淋巴结转移预测因子.闭孔、髂内、髂外三组淋巴结是最主要的前哨淋巴结.

Correlation between human papillomavirus DNA in the lymph nodes and metastasis of early-stage cervical carcinoma

OBJECTIVE: To investigate the correlation between the presence of human papillomavirus (HPV) DNA in the lymph nodes and histopathologically confirmed metastasis of early-stage cervical carcinoma. METHODS: HPV L1 gene fragment in paraffin-embedded tissue specimens of the primary tumor and pelvic lymph nodes from 31 patients with cervical cancer was amplified using HPV-specific PCR with general consensus primers GP5+/GP6+. The type of HPV was identified by sequence analysis of the PCR products, and the correlation between the presence of HPV DNA in the lymph node and the clinicopathological indices of cervical carcinoma was analyzed. RESULTS: The positivity rate of HPV DNA in the pelvic lymph nodes was 58.1% in the 31 patients, and in 13 of the patients with confirmed metastasis, the detection rate was 84.6% as compared with the rate of 27.8% in the other 18 patients without metastases. The presence of HPV DNA in the lymph node was associated with histologically confirmed metastases. The results of both HPV DNA detection and pathological examination indicated that the obturator, internal iliac and external iliac lymph nodes were more liable to be positive for HPV DNA, accounting for over 90% of the positivity. CONCLUSION: HPV DNA detection in the pelvic lymph nodes is a helpful predictive factor of metastases, and the obturator, internal iliac and external iliac lymph nodes are the among the most vulnerable lymph nodes of metastatic involvement by early-stage cervical carcinoma.