早期宫颈癌淋巴结转移规律研究进展

文章主要对盆腔淋巴结转移规律,术前评估淋巴结转移的方法,及影响盆腔淋巴结转移的相关因素进行综述,为早期宫颈癌手术治疗方式的个体化选择提供参考。     

声门上癌颈淋巴结转移的外科治疗

目的: 探讨声门上癌颈淋巴结转移的特点及颈清术在声门上癌外科治疗中的应用 方法: 分析210例声门上癌的颈淋巴结转移情况. 结果: 颈淋巴结转移率为47.6%,隐匿转移率为32.4%;行颈清术420例次,转移淋巴结535枚;不同肿瘤部位的转移率为:会厌室带51.9%,会厌33.3%,室带40.7%,杓会厌襞77.8%;不同肿瘤大小的转移率为:T1 14.7%,T2 37.7%,T3 53.4%,T4 77.6%;不同肿瘤分化程度的淋巴结转移率:G1 12.9%,G2 41.0%,G3 91.1% 结论: 声门上癌的颈淋巴结转移与肿瘤的部位、大小(T)、分化程度(G)密切相关,转移淋巴结主要位于Ⅱ、Ⅲ区,Ⅱ区淋巴结应为前哨淋巴结,对临床N+病例应行根治性颈清术,对G3、T3和T4、杓会厌襞癌或累及杓会厌襞的声门上癌的临床N0病例应行肩胛舌骨肌上颈清术.     

甲状腺乳头状癌经淋巴结转移规律及治疗策略

目的　探讨甲状腺癌的颈淋巴结转移规律及选择性颈淋巴结清扫术 ,应用于cN0 甲状腺乳头状癌病例的理论依据和应用原则。方法　前瞻性观察 3 0 0例甲状腺乳头状癌 ,分析cN0 pN (病理检查淋巴节阳性 )及cN pN 病例的颈淋巴结分布规律。结果cN pN 13 6例 ,cN0 pN 164例 ,颈淋巴结转移 2 5 1例 ,占 83 67% ,其中气管周围 2 2 8例 ,同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区分别为 1例、61例、2 41例、2 46例、5 9例 ;cN0 pN 115例 ,分布情况为气管周围 10 8例 ,同侧Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区分别为 0例、5例、10 5例、10 9例、3例 ;结论甲状腺乳头状癌淋巴结转移最常见于气管周围、颈部同侧Ⅲ、Ⅳ区。选择性颈淋巴结清扫术对cN0 甲状腺乳头状癌具有重要治疗作用。     

Predicting Factors for Pelvic Lymph Node Metastasis in Patients with Apparently Early-Stage Endometrial Cancer

Background: Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of postoperative complications. Aim of this study was to evaluate the prevalence and risk factors of pelvic lymph node metastasis (PLNM) in patients with apparently early-stage EC. Materials and methods: Two hundred and two patients with apparently early-stage EC who underwent surgical staging at Thammasat University Hospital between the years 2013 and 2020 were included in this retrospective study. Clinicopathological data and preoperative laboratory results were obtained from computer-based medical records. All data were statistically analyzed to determine the prevalence of PLNM and risk factors for developing PLNM. Results: PLNM was detected in 22 (10.9%) patients. Univariate analysis demonstrated that having grade 3 tumor, myometrial invasion of 50% or greater, vaginal involvement, cervical involvement, adnexal involvement, lower uterine segment involvement, lymphovascular space invasion (LVSI), and positive peritoneal cytology were associated with higher risk for developing PLNM. In addition, lower preoperative hemoglobin level and higher preoperative white blood cell count were significantly associated with PLNM. Multivariate analysis demonstrated that myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM (odds ratio (OR) 9.31, 95% confidence interval (CI) 2.58-33.55, p = 0.001, and OR 3.73, 95%CI 1.39-10.02, p = 0.009, respectively). Conclusions: Myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM in patients with apparently early-stage EC and thus lymphadenectomy in these patients should be provided.     

声门上区癌颈淋巴结转移的临床及病理探讨

目的：通过１００例声门上区癌的临床病理研究。分析其原发癌和颈淋巴结转移的关系。方法：临床颈淋巴结阴性的６３例中３０例只切除原发癌,术后１４例因颈淋巴结肿大而行治疗性颈清术,另３３例在切除原发癌的同时,行选择性上颈清除术;临床颈淋巴结阳性的３７例,均行了治疗性颈清术。结果：（１）１００例颈淋巴结转移率为５１％。（２）５１例颈淋转移癌中,有３５例转移癌侵至淋巴结包膜外,其中２１例治疗失败。３）１００例     

The Level of Squamous Cell Carcinoma Antigen and Lymph Node Metastasis in Locally Advanced Cervical Cancer

Background: This study aimed to determine the utility and a cut-off level of serum squamous cell carcinomaantigen (SCC-Ag) to predict lymph node metastasis in locally advanced cervical cancer cases. We also investigatedthe correlation between SCC-Ag level and lymph node status. Materials and Methods: From June 2009 to June2014, 232 patients with cervical cancer stage IB2-IVA, who were treated at Ramathibodi Hospital, were recruited.Receiver operating characteristic (ROC) curves were used to identify the best cut-off point of SCC-Ag level topredict lymph node metastasis. Quantile regression was performed to evaluate the correlation between SCC-Aglevels and pelvic lymph node metastasis, paraaortic lymph node metastasis, and parametrial involvement as wellas tumor size. Results: Pelvic lymph node metastasis and paraaortic lymph node metastasis were diagnosed in46.6% and 20.1% of the patients, respectively. The median SCC-Ag level was 6 ng/mL (range, 0.5 to 464.6 ng/mL). The areas under ROC curves between SCC-Ag level and pelvic lymph node metastasis, paraaotic lymphnode metastasis, parametrial involvements were low. SCC-Ag level was significantly correlated with paraaorticlymph node status (p=0.045) but not with pelvic lymph node status and parametrial involvement. SCC-Ag levelwas also related to the tumor diameter (p<0.05). Conclusions: SCC-Ag level is not a good predictor for pelvicand paraaortic lymph node metastasis. However, it is still beneficial to assess the tumor burden of squamouscell carcinoma of the cervix.     

术前超声分区诊断甲状腺癌颈淋巴结转移的临床价值

目的：探讨甲状腺癌颈部淋巴结转移的规律,评价术前超声分区诊断甲状腺癌颈部淋巴结转移的临床价值。方法：回顾性分析行颈部淋巴结清扫手术的568 例甲状腺癌患者的临床资料,术前均行甲状腺超声检查,同时对颈部转移性淋巴结进行分区,记录淋巴结的数量及在颈部Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ及Ⅻ区的分布,与术后病理进行比较。结果：超声诊断甲状腺癌的符合率为88% ,392 例淋巴结阳性病例中289 例患者为多分区转移,转移性淋巴结在颈部的分布以Ⅱ、Ⅲ、Ⅳ、Ⅵ区为主,Ⅴ、Ⅻ区转移性淋巴结分布较少。术前超声对颈部淋巴结诊断的总体符合率为80% ,术前超声分区对Ⅲ、Ⅳ、Ⅵ及Ⅶ区的转移性淋巴结的诊断符合率较高。结论：术前超声诊断转移性淋巴结的临床符合率较高。甲状腺癌的颈部淋巴转移为多分区分布,术前超声分区对Ⅲ、Ⅳ、Ⅵ及Ⅶ区转移性淋巴结的诊断符合率较高,可以做到定位、定性及定量诊断,指导临床手术方式的选择,患者术前行超声检查时应常规对颈部淋巴结进行术前分区。     

中晚期喉癌患者颈部淋巴结转移状况及相关影响因素分析

目的：探讨中晚期喉癌患者颈部淋巴结转移情况及相关影响因素。方法回顾性分析68例中晚期喉癌患者颈部淋巴结转移与肿瘤原发部位、T分期、N分期、病理分级、临床分期、淋巴结受累侧数的关系,应用Logistic回归分析喉癌淋巴结转移相关因素和喉癌患者死亡的危险因素。结果68例患者中有16例发生淋巴结转移,转移率为23．53％。 Logistic回归分析的因素包括年龄、性别、病变部位、病理分级、T分期、N分期、临床分期、淋巴结受累侧数,结果显示,病理分级（P＝0．001）、T分期（P＝0．021）、临床分期（P＝0．007）是喉癌淋巴结转移的相关因素。淋巴结转移（P＝0．001）与T分期（P＝0．003）是喉癌患者死亡的危险因素,而N分期和病理分级对于喉癌患者死亡的影响差异无统计学意义。结论中晚期喉癌患者颈部淋巴结转移情况与病理分级、T分期、临床分期有关,喉癌患者的死亡因素与淋巴结转移和T分期相关。     

放化疗联合热疗治疗颈部淋巴结转移鼻咽癌的疗效观察

目的观察放化疗联合热疗治疗颈淋巴结转移鼻咽癌的疗效。方法 160例初治颈淋巴结转移鼻咽癌患者随机分为对照组(90例)和热疗组(70例)。对照组:接受氟尿嘧啶+顺铂化疗后原发灶和颈淋巴结转移灶均接受常规放疗。热疗组:放化疗方法同对照组,颈淋巴结转移灶于放疗第1周开始配合局部热疗。结果热疗组和对照组5 a无瘤生存率分别为51.4%、21.1%(χ2=16.043,P<0.05),5 a生存率分别为58.6%、41.1%(χ2=4.805,P<0.05),5 a颈淋巴结局部控制率分别为97.1%、76.7%(χ2=13.413,P<0.05),5 a远处转移率分别为37.1%、44.4%(χ2=0.866,P>0.05)。结论放化疗联合热疗治疗颈淋巴结转移鼻咽癌的近远期疗效均优于单纯放化疗。     

超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值

目的 探究超声诊断甲状腺癌颈部淋巴结转移的特点及其临床诊断价值.方法 选取51例甲状腺癌患者为研究对象,利用超声对患者的甲状腺及颈部肿大淋巴结进行诊断,并将超声诊断结果与术后病理诊断结果进行比较.结果 经超声探测的51例患者颈部转移性淋巴结为109枚,非转移性淋巴结16枚;术后病理检测患者颈部转移性淋巴结98枚,非转移性淋巴结12枚.与术后病理检测结果对比,利用超声检测患者颈部淋巴结转移的准确率为88.0％,敏感度为64.8％,特异度为85.3％,阳性预测值为80.7％,阴性预测值为66.7％.超声对多个淋巴结转移的检出率明显高于单个淋巴结转移的检出率,二者差异有统计学意义(x2=6.736,P=0.031);甲状腺癌肿瘤边界不清或呈锯齿状、肿瘤直径＞2 cm的颈部淋巴结转移率较高,并且转移性淋巴结的血流信号多于非转移性淋巴结,差异有统计学意义(P＜0.05).结论 利用超声诊断甲状腺癌颈部淋巴结转移的准确率较高,可在临床推广应用.     

T1期非小细胞肺癌纵隔淋巴结转移规律及清扫方式研究进展

肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer,NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。     

Comparing Early-Stage Breast Cancer Patients with Sentinel Lymph Node Metastasis with and without Completion Axillary Lymph Node Dissection: A Systematic Review and Meta-Analysis

Background: Currently, the standard method for staging and treatment of axillary lymph nodes for early-stage breast cancer is sentinel lymph node biopsy (SLNB), while axillary lymph node dissection (ALND) is used in cases with palpable axillary lymph nodes or positive SLNB cases. The aim of this review was to compare overall survival (OS), disease-free survival (DFS), and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND. Methods: The databases of PubMed, Scopus, and Cochrane Library were searched using the key words of “breast cancer”, “axillary lymph node dissection”, and “sentinel lymph node dissection”. In addition, other sources were searched for ongoing studies (i.e., clinicaltrials.gov). The clinical trials were evaluated based on the Jadad quality criteria, and cohort studies were evaluated according to the STROBE criteria. At the end of the search, the articles were screened independently by two reviewers to check their eligibility to be included in the study. Afterwards, the data were extracted independently by two researchers. Results: After searching the databases, 169 papers were retrieved. However, after removing the duplicates and studying the titles and abstracts of these papers, only ten ones underwent further investigation. After reading full-text of each article, four studies were finalized. Following a manual search, 27 papers were entered into the study for the final evaluation, 11 of which were included in the meta-analysis based on the inclusion and exclusion criteria. The findings showed no significant differences in OS, DFS, and axillary recurrence in early-stage breast cancer patients underwent SLNB or SLNB and completion ALND. Conclusion: The findings did not confirm that ALND improved OS, DFS, and axillary recurrence in patients who were clinically node-negative and positive SLNB.     

宫颈癌患者淋巴结转移的影响因素分析

目的探讨宫颈癌患者淋巴结转移的分布规律、高危因素。方法选取均经活检或手术病理证实的71例宫颈癌患者为研究对象,对影响淋巴结转移的因素采用Logistic多因素回归分析。结果71例宫颈癌患者中有14例患者发生淋巴结转移,转移率为19．7％;单因素分析结果显示肿瘤直径、SCCAg水平、FIGO分期、病理分型、肌层浸润深度、脉管侵犯、分化程度与淋巴结转移相关（P〈0．05）,而年龄、手术切缘与淋巴结转移不具相关性（P〉0．05）;Logistic多因素回归分析结果显示治疗前SCCAg水平、脉管侵犯、FIGO分期、肌层浸润深度以及分化程度5个因素是淋巴结转移的独立危险因素。结论治疗前SCCAg〉4ng／ml、宫颈浸润深度≥肌层1／2、脉管侵犯、FIGO分期较晚及细胞分化程度较高是宫颈癌盆腔淋巴结转移的主要危险因素。     

MACC1、c-Met蛋白在宫颈癌组织中的表达及其与盆腔淋巴结转移的相关性

目的 研究结肠癌转移相关基因(MACC1)和人原癌基因编码蛋白(c-Met)在宫颈癌组织中的表达及其与盆腔淋巴结转移的相关性.方法 应用免疫组织化学法对MACC1和c-Met蛋白在不同宫颈组织中的表达情况进行检测,分析其表达情况与盆腔淋巴结转移之间的关系.结果 MACC1和c-Met蛋白在宫颈癌组、CINⅡ~Ⅲ组和正常宫颈组中的阳性表达率比较有明显差异(P<0.05);3组间MACC1和c-Met蛋白阳性表达率进行两两比较,差异均有统计学意义(P<0.05).Spearman等级相关性检验结果表明,MACC1和c-Met蛋白的表达呈正相关关系(γ=0.632,P=0.000).肌层浸润深度及MACC1和c-Met蛋白阳性表达是影响宫颈癌盆腔淋巴结转移的独立危险因素(P<0.05).结论 MACC1和c-Met蛋白可能参与了宫颈癌的发生、发展,并与宫颈癌的侵袭转移有关,是宫颈癌盆腔淋巴结转移的独立高危因素,有重要的临床价值.     

大肠癌淋巴结转移的相关病理因素368例分析

目的　探讨大肠癌淋巴结转移相关的病理学因素。方法　对 3 68例大肠癌切除标本按统一标准 ,进行组织学分类、浸润深度、癌周淋巴细胞反应等项检查 ,探讨其与淋巴结内癌转移的关系。结果　淋巴结内癌转移率为 3 3 4% ,其中肠旁组淋巴结转移率占 77 2 % ,肠系膜淋巴结及系膜动脉结扎处淋巴结转移率占 17 9%和 4 9%。癌肿长径 >6cm及浸润深度达浆膜外 ,癌周淋巴细胞反应强度 > 时癌转移率最高 (P <0 0 0 5 ) ,组织学分级级别越高 ,癌转移率越高。组织类型与癌转移率有明显相关性 (P <0 0 5 ) ;结论　大肠癌淋巴结内癌转移以肠旁组为主 ,常为逐站转移 ,转移率与肿瘤大小、浸润深度呈正相关 ,与分化程度及淋巴细胞反应强度呈负相关 ,与组织学类型有明显相关性。     

208例食管癌淋巴结转移的临床病理分析

目的探讨食管癌淋巴结转移的规律,相关因素及临床意义。方法对208例食管癌根治术后的临床病理资料进行分析。结果208例中124例发现淋巴结转移,转移率为59．62％（131／208）清扫淋巴结2651个,其中430个淋巴结转移,淋巴结的转移率为16．22％（430／2651）,并讨论了影响淋巴结转移的相关因素。结论对中上段食管癌应行全胸段食管切除,食管胃颈部吻合,彻底清扫各组淋巴结,才能达到根治目的。     

肿瘤位置等临床病理特征与分化型甲状腺癌淋巴结转移的关系

目的 探讨肿瘤位置、体积及甲状腺被膜浸润情况等临床病理特征与分化型甲状腺癌颈淋巴结转移的关系。方法 回顾性分析2010年7月至2013年7月四川省肿瘤医院头颈外科收治的初次手术治疗的248例患者临床及病理资料。结果 肿块位置、最大直径、数量、浸出腺体外膜及受累腺叶数等特征对Ⅵ区和Ⅱ~Ⅴ区淋巴结状态均有影响;低龄与Ⅵ区淋巴结转移有关。肿块位于下极时,Ⅵ区阳转率最高达74.29%,Ⅱ~Ⅴ区仅45.00%,而当肿块位于上极时Ⅵ区为58.33%,Ⅱ~Ⅴ区却高达84.21%。肿块直径＞1 cm和2 cm分别为中央区和颈侧区阳转率上升的临界值。结论 肿块位于下极、直径>1 cm、多发、多叶受累、浸出被膜、低龄这些特征可作为中央区淋巴结转移的高危因素;而肿块处于上极、直径＞2 cm、多发、多叶受累、浸出被膜等特征可能为颈侧区淋巴结转移的高危因素;应当尤其注意肿块位置与不同区域淋巴结状态的关系以及肿块体积作为区域淋巴结转移的高危因素时其临界值可能不同。     

甲状腺癌颈部淋巴结转移区域的超声特点研究

目的：探究甲状腺癌颈部淋巴结转移区域的超声特点。方法回顾性分析58例甲状腺癌患者的临床资料。将患者术前颈部淋巴结转移区域的超声诊断与患者的病理诊断进行比较,分析其超声表现的特点。结果58例患者中经术前超声诊断显示,有36例（62．07％）颈部淋巴结转移,其中3例单纯中央区淋巴结转移、18例单纯颈侧区淋巴结转移、15例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为31．03％,显著低于颈侧区淋巴结转移率56．89％。病理诊断结果显示,58例患者中有33例（56．89％）颈部淋巴结转移,其中21例单纯中央区淋巴结转移,2例单纯颈侧区淋巴结转移,10例颈侧区合并中央区淋巴结转移;中央区淋巴结转移率为53．44％,显著高于颈侧区淋巴结转移率20．68％。超声诊断颈部转移性淋巴结的特异性为80．0％（12／15）,敏感性为100．0％（33／33）。超声检查对中央区转移性淋巴结的检出率为58．06％（18／31）,显著低于颈侧区转移性淋巴结的检出率100．0％（12／12）。超声诊断颈侧区淋巴结转移与病理结果的符合率为36．36％（12／33）,显著低于中央区淋巴结转移与病理结果的符合率58．06％（18／31）,差异具有统计学意义（P＜0．05）。颈侧区和中央区中淋巴门回声消失和低回声占较高的比例,且颈侧区和中央区颈侧区转移性淋巴结中L／T＜2所占的比例差异具有统计学意义（P＜0．05）。结论甲状腺癌多转移至颈部中央区淋巴结,采用超声检查具有较高的特异性,对中央区淋巴结的诊断有十分重要的意义。     

胸段食管癌淋巴结转移规律分析(附150例报告)

[目的]研究胸段食管癌淋巴结转移规律。[方法]对胸段食管鳞癌切除手术标本150例的淋巴结进行分组制片、光镜观察。[结果]150例病人有淋巴结转移者81例 ,转移率54 0 % ,病变长度≤5cm者 ,转移率为32 3% ,>5cm者为70 6%。淋巴结转移以局部转移多见 ,其次为连续性及跳跃转移 ,淋巴结转移呈向上、向下及双向转移的多方向性为又一特点。[结论]根据淋巴结的转移特性重视术中淋巴结的清扫及术后给以有目的综合治疗 ,可望提高中晚期食管癌的治疗效果。     

低位直肠癌侧方淋巴结转移的影响因素

目的 分析低位直肠癌侧方淋巴结转移相关临床病理因素.方法 采用单因素和logistic多因素回归分析方法,分析低位直肠癌侧方淋巴结转移与其临床病理因素的关系.结果 患者性别、年龄、肿瘤位置、肿瘤占肠腔周径、Ki-67表达与侧方淋巴结转移无明显相关性,而肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达与侧方淋巴结转移相关.其影响作用大小的顺序为:浸润深度>血清CEA浓度>肿瘤最大直径>E-cad表达.结论 直肠癌侧方淋巴结转移率较低,不推荐常规行侧方淋巴结清扫;肿瘤浸润深度、肿瘤直径、血清CEA含量、E-cad表达是影响低位直肠癌侧方淋巴结转移的因素,对临床上手术方式的制定有一定参考价值.