盆腔淋巴结CT检测对根治性放化疗子宫颈癌患者生存的预测价值

目的以治疗前CT评估盆腹腔淋巴结转移状况，探讨其对根治性放化疗子宫颈癌患者的预测价值。方法回顾性分析2005年4月至2009年11月期间在汕头大学医学院附属肿瘤医院放疗科行根治性放化疗的209例ⅠB～ⅣA期子宫颈癌患者治疗前的CT资料，分别以部位、数目、大小三种方法评估盆腹腔淋巴结转移状况。利用Kaplan．Meier法分析淋巴结转移状况及其他临床病理因素对患者总生存的影响，并采用Cox回归模型进行多因素分析。结果ⅠB、Ⅱ、Ⅲ、ⅣA期患者淋巴结转移率分别为16．7％（1／6）、48．2％（68／141）、57．4％（31／54）、87．5％（7／8）。单因素分析显示国际妇产科协会（FIGO）分期晚、治疗前贫血、腹主动脉旁淋巴结转移、淋巴结转移数目≥3个、转移淋巴结最大径〉12．0em为预后不良因素（P〈0．05）；Cox回归模型显示FIGO分期、淋巴结转移数目、病理类型及治疗方式为独立预后因素。结论在同步放化疗模式下，以治疗前CT评估淋巴结转移状况仍然可以很好的预测预后。

Prognostic value of lymph node status evaluated by computed tomography for patients with cervical cancer treated with radical chemoradiation therapy

Objective To investigate the prognostic value of lymph node status evaluated by computed tomography （CT） in cervical carcinoma treated with radical chemoradiation therapy. Methods 209 patients with FIGO stage ⅠB--ⅣA uterine cervical carcinoma treated with radical chemo radiation therapy were enrolled. Lymph node status was evaluated based on site, number and size respectively by CT. Kaplan-Meier method was used to analyze the impact of lymph node status as well as other pathoclinical factors on overall survival （OS）. Cox regression model was used to explore the relationship between independent prognostic factors and OS. Results Lymph node metastasis rates for stage ⅠB, Ⅱ, Ⅲ and ⅣA patients were 16.7 % （1/6）, 48.2 % （68/141）, 57.4 % （31/54） and 87.5 % （7/8）, respectively. Variate analysis showed that FIGO stage, anemia before treatment, para-aortic lymph node metastasis, and the number （I〉3） and size （maximum diameter ≥ 2.0 cm） of CT positive lymph node were significant unfavorable prognostic factors for OS （P 〈 0.05）. FIGO stage, the number of lymph nodes metastasis, pathologic diagnosis and treatment regimen were identified to be independent prognostic factors in multivariate analysis. Conclusion Under current therapeutic strategy of concomitant chemoradiotherapy, lymph node metastatic status evaluated by pretreatment CT is still a significant and independent prognostic factor for cervical cancer.