有关宫颈癌术后淋巴结转移的探讨

宫颈癌根治术的成功与否,术后盆腔淋巴结有无转移是关键所在。这一点已被越来越多的学者所承认。如能在术前对疾病存在的形态学,组织学特征加以分析,明确可能导致淋巴结转移的潜在因素,从而制定切实可行的治疗     

ⅠⅡ期宫颈癌根治术后淋巴结转移与预后初探

１９７８年￣１９８７年，我院手术治疗Ⅰ、Ⅱ期宫颈癌１９４例，其中Ｉ期１５３例，Ⅱ期４１例。术后病理证实２６例有盆腔淋巴结转移，Ｉ期转移率为１０．５％，Ⅱ期转移率为２４．４％。２６例患者中，２０例术前经半量腔内放疗，２６例均于术后均予以＾６０Ｃｏ外照射，ＤＴ４５Ｇｙ￣５０Ｇｙ。本组病人均随访５年以上，随访率９９．０％。５年生存率无转移组９５．２％，转移组５７．７％。作者讨论了有关淋巴结转移的潜在因素     

宫颈癌根治术后盆腔淋巴结转移的预后研究

背景与目的:盆腔淋巴结转移是影响宫颈癌预后的重要因素,但是淋巴结阳性数、淋巴结转移部位及术后辅助治疗与预后的关系,尚有待探讨。本研究拟探讨Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时影响预后的危险因素。方法:回顾性分析66例根治术后证实有盆腔淋巴结转移的Ⅰb～Ⅱb期(FIGO分期)宫颈癌患者的临床资料,对可能影响预后的有关因素进行Cox比例风险模型分析。结果:66例盆腔淋巴结转移患者的5年总生存率为40.7％。Cox比例风险模型分析结果显示:肿瘤分化程度、淋巴结转移数目和术后辅助治疗是影响预后的重要危险因素(P<0.05)。1枚淋巴结转移患者的5年总体生存率(56.5％)明显高于2枚或2枚以上淋巴结转移的患者(36.4％)(P<0.05),前者远处转移率(5.9％)低于后者(32.7％)(P=0.05),而两组患者盆腔复发率无显著性差异(P>0.05)。术后未予辅助治疗患者的5年生存率(12.6％)明显低于术后辅助治疗者(53.7％)(P< 0.05),而辅助放疗组、辅助化疗组与辅助放化疗组患者的5年生存率差异无统计学意义(P>0.05)。结论:Ⅰb～Ⅱb期宫颈癌根治术后有盆腔淋巴结转移时预后差,术后辅助治疗能提高患者生存率,减少盆腔复发和远处转移。     

宫颈癌盆腔淋巴结转移根治性放疗的疗效

目的探讨宫颈癌盆腔淋巴结转移根治性放疗的疗效和不良反应。方法对48例盆腔淋巴结转移的宫颈癌患者行根治性放疗,44例同时辅助全身化疗。采用6～18 MVX射线前后对穿两野或前后对穿两野+左右侧野的四野照射,全盆腔照射DT30～40 Gy后中间铅挡加量DT10～20 Gy,使B点DT达50 Gy。盆腔转移的淋巴结局部小野补量(RT)照射,每次DT2 Gy,总DT8～10 Gy,高剂量后装治疗(HDR)采用核通后装机治疗,192Ir治疗,选取A点参考点,处方剂量为600～700 cGy,每周1次,共6次。结果随访时间为22～43个月,中位随访时间31个月,随访率100.00%。PR、CR分别达100.00%和83.33%(40/48),盆腔转移淋巴结完全有效率为85.42%(41/48)。结论盆腔转移淋巴结照射剂量达60 Gy以上,疗效好,无严重消化道不良反应发生。     

宫颈癌盆腔淋巴结转移情况分析

目的　分析宫颈癌患者盆腔淋巴结转移情况及淋巴结状态与临床病理的关系,以指导临床治疗。方法　回顾性分析了以手术治疗为主的Ⅰb、Ⅱ期宫颈癌228例中的42例淋巴结转移病例,淋巴结转移率18.42%。对淋巴结分布、状态及与临床病理的关系进行分析。结果　切除的淋巴结数目12~36个,平均23个。转移部位以闭孔最多,其余依次为髂内、髂外、髂总、股深淋巴结,左侧多于右侧, (P<0. 05)。髂总淋巴结转移率为1. 31 %, 3例髂总淋巴结阳性者皆为临床分期Ⅱ期、生长类型为内生型。双侧盆腔淋巴结转移率为6.59%,内生型者、肿瘤直径≥4cm发生双侧盆腔淋巴结转移率高,且差异有显著性(P<0. 01)。25例发生2个或2个以上淋巴结转移,其中肿瘤直径≥4cm、内生型者易有多个淋巴结转移且有统计学意义(P<0. 05)。结论　盆腔淋巴结切除对临床Ⅰb、Ⅱ期宫颈癌是必要的,但无常规行腹主动脉旁淋巴结清扫的必要性。盆腔淋巴结状态及相关临床病理因素可作为预后指标,以便术后补充治疗。     

宫颈癌盆腔淋巴结转移相关因素分析

目的 :了解子宫颈癌盆腔淋巴结转移的相关因素。方法 :对 3 0 5例ⅠA～ⅡB期宫颈癌行根治术的临床资料进行回顾性分析。结果 :ⅠA期宫颈癌盆腔淋巴结转移率 0 ,ⅠB期为 9 8% ,ⅡA期为 18 5 2 % ,ⅡB期为 5 7 14 % ;宫颈鳞癌盆腔淋巴结转移率为 8 2 % ,宫颈腺癌为42 2 7% ;宫颈癌高分化组盆腔淋巴结转移率为 0 ,中分化组为 11 16% ,低分化组为 40 62 % ;宫颈间质浸润深度 <1/ 2组盆腔淋巴结转移率为 1 2 3 % ,≥ 1/ 2组为2 1 88% ;宫颈癌糜烂型盆腔淋巴结转移率为 17 0 2 % ,外生型为 13 95 % ,内生型为 18 5 2 % ,溃疡型为 41 67% ;宫颈肿瘤≥ 4cm者盆腔淋巴结转移率为 2 0 0 % ,<4cm者为 12 14 % ;手术前予化疗者盆腔淋巴结转移率为 7 4% ,未行化疗者为19 5 6% ;手术前行放疗者盆腔淋巴结转移率为 4 76% ,未行放疗者为 19 5 6%。结论 :宫颈癌患者的临床分期、病理分级、组织类型、宫颈间质浸润深度、生长方式及术前化疗或放疗与盆腔淋巴结转移有直接关系 ,而肿瘤大小与盆腔淋巴结转移关系不明显。     

宫颈癌盆腔淋巴结转移相关因素分析

目的:探讨宫颈癌盆腔淋巴结转移相关因素。方法:回顾性分析634例广泛性子宫切除及盆腔淋巴结清扫术后宫颈癌患者的临床分期及病理资料。结果:盆腔淋巴结总转移率为18.76%(119/634),年龄、临床分期、肿瘤浸润深度、肿瘤生长形态、肿瘤细胞分化程度与淋巴结转移显著相关。病理类型、病灶大小、术前放化疗与淋巴结转移无相关性。结论:年龄≤35岁,临床分期晚,肿瘤浸润≥1/2,溃疡型肿瘤,病理分化差均为宫颈癌淋巴转移高危因素。     

宫颈癌盆腔淋巴结转移相关因素分析

目的：探讨宫颈癌盆腔淋巴结转移相关因素。方法：回顾性分析634例广泛性子宫切除及盆腔淋巴结清扫术后宫颈癌患者的临床分期及病理资料。结果：盆腔淋巴结总转移率为18.76%（119/634）,年龄、临床分期、肿瘤浸润深度、肿瘤生长形态、肿瘤细胞分化程度与淋巴结转移显著相关。病理类型、病灶大小、术前放化疗与淋巴结转移无相关性。结论：年龄≤35岁,临床分期晚,肿瘤浸润≥1/2,溃疡型肿瘤,病理分化差均为宫颈癌淋巴转移高危因素。     

宫颈癌盆腔淋巴结转移85例放疗分析

宫颈癌盆腔淋巴结转移８５例放疗分析俞华，楼洪坤根治性子宫切除加盆腔淋巴清扫术是早期宫颈浸润癌的首选治疗方法，具有良好的疗效，但仍有少数病人术后复发，为探讨盆腔淋巴结转移对宫颈癌预后的影响及术后盆腔放疗的价值，现将１９８１年作者单位：浙江省肿瘤医院（３...     

1至3个腋窝淋巴结转移乳腺癌根治术后放疗的应用

腋窝淋巴结转移数目为1～3个的早期乳腺癌患者是否需行术后辅助放疗是目前争议的焦点.多个随机研究结果提示,包括全胸壁及相关淋巴结引流区的术后放疗能改善1～3个腋窝淋巴结转移者的局部控制率和生存率.是否行术后放疗取决于肿瘤大小和分期、淋巴结清扫数和淋巴结阳性率、淋巴结包膜外侵犯和脉管瘤栓等因素.最佳放疗方式和患者选择尚有待进一步前瞻性随机对照临床试验来验证.     

Prognostic factors and treatment outcome after radiotherapy in cervical cancer patients with isolated para-aortic lymph node metastases

Objective

The purpose of the present study was to evaluate treatment outcomes and prognostic factors in cervical cancer patients with isolated para-aortic lymph node (PALN) metastases. We especially tried to evaluate PALN factors such as size, site and number.

Methods

From August 1994 to December 2009, 40 cervical cancer patients with isolated PALN node metastases at initial diagnosis were selected for analysis. Patients underwent both extended field external beam and intracavitary brachytherapy. Fourteen patients received 5-fluorouracil and cisplatin (FP) and 16 patients received weekly concurrent cisplatin. Information of PALN, such as size, site, and number, was founded before PALN radiotherapy.

Results

The median follow-up time after primary treatment was 28.5 months (range, 2 to 213 months). The 3-year overall and progression-free survival rate after primary treatment was 44.3% and 31.3%, respectively. In multivariate analysis including tumor stage, performance status, and chemotherapy, FP regimen concurrent chemoradiotherapy was more effective than radiotherapy alone (p=0.030). The 3-year progression-free survival rate was 41.9% and 11.1% in patients with PALN numbers of ≤1 and ≥2, respectively (p=0.008). The 3-year progression-free survival rate was 42.1% and 19.2% in patients with PALN size of <1.5 cm and ≥1.5 cm, respectively (p=0.031).

Conclusion

The radiologic features of PALN, such as number or size, can be used to determine prognosis in PALN metastatic cervical cancer patients. Furthermore, FP regimen concurrent chemoradiotherapy was associated with better patient survival than radiotherapy alone. However, more studies are required to confirm possible different treatment outcomes between FP and weekly cisplatin regimens.     

Preliminary report of using FDG-PET to detect extrapelvic lesions in cervical cancer patients with enlarged pelvic lymph nodes on MRI/CT

PURPOSE: To evaluate, in a prospective study, the effects of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) on the detection of extrapelvic lesions, the design of whole pelvis or extended field radiotherapy, and subsequent failure patterns for patients with cervical cancer and enlarged pelvic lymph nodes (LNs) shown on MRI or CT. METHODS AND MATERIALS: Between April and December 2001, 19 consecutive patients underwent an additional FDG-PET examination before concurrent chemoradiotherapy. The inclusion criteria for the study were at least one enlarged pelvic LN > or =10 mm in its maximal dimension as shown on radiologic images and no extrapelvic tumors detected by conventional examination. The PET findings of the primary tumor, pelvic LNs, and extrapelvic lesions were investigated and compared with the MRI/CT findings. Tumor FDG uptake was quantitated with the maximal pixel standardized uptake value. RESULTS: Except for 1 patient with diabetes mellitus who was excluded from analysis, 18 cervical tumors had significant FDG uptake (maximal pixel standardized uptake value >8). A total of 39 pelvic LNs were reported, and the agreement of positive pelvic LNs between MRI/CT and PET was 79.5%. Five patients (28%) had positive paraaortic LNs on FDG-PET, and their treatment fields were extended to include the paraaortic region. In addition to the paraaortic LNs, 1 patient also had metastasis at the left supraclavicular node. After a minimum follow-up of 12 months (median 15.9), 4 patients (22.2%) developed new extrapelvic metastases. The disease-free survival rate was 78% at 12 months. CONCLUSION: FDG-PET is a useful tool to detect paraaortic LN metastasis and determine the appropriate treatment field for cervical cancer with enlarged pelvic LNs on MRI/CT. The preliminary data suggest that pretreatment FDG-PET can supplement conventional imaging studies, but still has limitations in the detection of microscopic disease.     

SHORT－TIME ANALYSIS FOR ADJUVANT CHEMOTHERAPY IN PATIENTS WITH EARLY－STAGE BULKY CERVICAL CARCINOMA

Bulky early-stage cervical cancer is defined as stage I~IIa cervical carcinoma with the diameter of enlarged cervix reaching 4 centimeters or more. These patients have higher recurrence rate and poor prognosis compared to those with smaller tumors at the same stage[1-3]. In or study, 21 patients with early-stage bulky cervical cancer were assigned to receive the addition of cisplatin-based chemotherapy for 1~2 courses followed by radical hysterectomy and the effect was analyzed. MATERIS…     

无淋巴结转移的结直肠癌患者淋巴结切除数目对预后的影响

结直肠癌是我国最常见的癌症死亡原因之一。术中切除的淋巴结数目与结直肠癌患者的预后密切相关,特别是对无淋巴结转移的患者具有重要的临床意义。其机制可能包括淋巴结错误病理分期及淋巴结微转移等。因此,术中规范地进行淋巴结清扫,术后对高危患者进行强化治疗,提高微转移检测手段等对结直肠癌患者的预后具有重要作用。     

无淋巴结转移的结直肠癌患者淋巴结切除数目对预后的影响

结直肠癌是我国最常见的癌症死亡原因之一。术中切除的淋巴结数目与结直肠癌患者的预后密切相关,特别是对无淋巴结转移的患者具有重要的临床意义。其机制可能包括淋巴结错误病理分期及淋巴结微转移等。因此,术中规范地进行淋巴结清扫,术后对高危患者进行强化治疗,提高微转移检测手段等对结直肠癌患者的预后具有重要作用。     

晚期上皮性卵巢癌术后辅助化疗与放疗

对晚期上皮性卵巢癌减瘤术后辅助化疗及放疗的结果进行比较分析。材料与方法对５２例已行初次减瘤术的Ⅲｃ、Ⅳ期上皮性卵巢癌病人随机分成腹腔化疗＋静脉化疗（化疗组）和放疗＋静脉化疗（放疗组）２组，给予药物及放射治疗。结果化疗及放疗２组病人５年生存率分别是２７．３％和３６．７％，无明显差异。无严重并发症。结论对控制晚期上皮性卵巢癌减瘤术后腹腔残余癌，腹腔化疗＋静脉化疗及放疗＋静脉化疗同样有效，且较术后单纯静脉化疗效果好。     

放疗合并化疗治疗晚期宫颈癌的疗效观察

对60例晚期宫颈癌患者分别采用常规根治量放疗加VPB方案化疗（治疗组）和单行根治量放疗（对照组）、结果表明：治疗组患者的宫颈局部肿瘤缩小和消失时间校对照组明显缩短,宫颈局部肿瘤缩小50％所需放射剂量亦校对照组减少;治疗组未出现严重毒性反应,患者对治疗耐受性良好。     

宫颈癌术后淋巴结转移相关因素分析

目的　探讨宫颈癌根治术后淋巴结转移的相关因素。方法　回顾性分析 135例宫颈癌根治术后盆腔淋巴结转移者的相关因素。结果　临床分期、病理分级、浸润深度、肿瘤大小及形态、年龄与淋巴结转移呈显著相关 ,病理类型与淋巴结转移无相关意义。结论　临床分期晚、病理分级差、肌层浸润 >1/ 3、肿瘤直径≥ 3cm、内生型肿瘤、年龄≤ 40岁为淋巴结转移高危因素