子宫颈癌伴盆腔淋巴结转移患者的复发及预后分析

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月问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I b1～II a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.O%,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.O%(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.

Analysis of recurrence pattern and prognosis of patients with cervical envenoms and pelvic lymph node metastasis

0bjective To investigate the pattern of disease relapse and prognostic risk factor of patients with cervical carcinoma and pelvic lymph node metastasis.Methotis A total of 124 cases of International Federation of Gynecology and Obstetricfi(FIG0)I bl-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 flun,ival 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=O.035).According to this factor,node-positive patients could be divided into low risk group(without common iliac node involvement,104 cases)and hiSh 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-pelvicrelapse wag seen in 7.7%(8/104)of low risk and 40.0%(8/20)of hish 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 iliae nodes have significantly decreased 5 year disease.free survival and hishcr extra-pelvic disease recurrence rates compared with those whose common iliac nodes are negative.These findings provide impo.rtant data for design of individualized treatment mode.