检测盆腔淋巴结HPV-DNA预测病理诊断淋巴结阴性宫颈癌的复发

目的探讨检测盆腔淋巴结的人乳头状瘤病毒DNA，以预测病理诊断淋巴结阴性宫颈癌的复发。方法对8例术后病理诊断淋巴结转移阳性患者的原发病灶和淋巴结转移病灶的石蜡包埋标本进行荧光定量PCR检测HPV-DNA，作为阳性对照。对20例病理诊断盆腔淋巴结转移阴性而临床上出现复发的患者进行荧光定量PCR检测其原发病灶和盆腔淋巴结石蜡包埋标本中的HPV-DNA。随机选择20例病理诊断无淋巴结转移临床上也无复发的患者，进行上述同样的原发灶和盆腔淋巴结的HPV-DNA检测。结果在8例病理诊断盆腔淋巴结转移阳性病灶中，均检测出与原发病灶型别完全相一致的HPV-DNA。在20例病理诊断无盆腔淋巴结转移而临床上复发的患者中，18例检测出与原发病灶型别完全相一致的HPV-DNA，占90％。在20例病理上无盆腔淋巴结转移、临床上也无复发者中，除了1个盆腔淋巴结检测出HPV—DNA外，其余19例均未检测出任何的HPV-DNA。结论在病理诊断盆腔淋巴结转移阴性的宫颈癌患者中，盆腔淋巴结HPV-DNA阳性提示可能存在早期微小淋巴结转移或同时存在不能发现的血性转移，因此，盆腔淋巴结HPV-DNA的检测结果可以作为一项诊断指标，以预测这部分宫颈癌患者的术后复发。

Detection of Human Papilloma Virus DNA in Pelvic Lymph Nodes to Predict Unexpected Recurrence of Cervical Cancer in Patients without Histologically Lymph Node Metastases

Objective Patients with cervical cancer without any evidence of pelvic lymph node metastases histologically are supposed to have a fair prognosis, but some of these patients develop recurrent disease unexpeetedly after surgery. The objective of this study is to examine whether the detection of human papilloma virus （HPV）DNA in pelvic lymph nodes could be used as a diagnostic marker to predict such recurrence. Methods Eight of thirty-nine patients with histologically positive pelvic lymph nodes were examined by a continuous fluorescence PCR to detect HPV-DNA from archival primary lesions and corresponding lymph nodes with definite tumor nests. In 20 patients with histologically confirmed negative pelvic lymph nodes whose disease recurred after surgery, corresponding archival primary site and pelvic lymph node specimen were available for detection of HPV-DNA by the same PCR. Twenty patients without histologically confirmed pelvic lymph node metastases were randomly selected from patients without evidence of disease within a minimum of 24 months of follow-up after surgery. Their archival primary lesions and pelvic lymph nodes were examined for HPV-DNA in the same manner as that above. Results HPV sequences identical to those of the primary sites were detected in all of this 8 histologically confirmed positive pelvic lymph nodes. In 18 of the 20 patients with histologically negative lymph nodes who recurred after surgery, the identical HPV-DNA types as in the primary sites were displayed in either of these histologically negative pelvic lymph nodes（positive 90M）. Histologically confirmed negative pelvic lymph nodes from twenty patients without evidence of disease were analyzed for the presence of HPV-DNA, however, except for one lymph node which had HPV-DNA,they did not contain any HPV sequence. Conclusion The presence of HPV-DNA in histologically negative pelvic lymph nodes implies the possibility of early nodal involvement or coexistence of undetectable hematogenic dissemination and could therefore be used as a diagnostic marker to predict the unexpected recurrence of these patients.