MRI评估宫颈癌病变范围的临床分析

目的评价磁共振成像对宫颈癌分期的价值。方法对33例宫颈癌患者在手术前进行磁共振成像(MRI)检查,依临床分期制定治疗计划。以术后病理诊断为金标准,将临床、磁共振成像分期结果中癌浸润的部位和范围、淋巴结转移,尤其对宫旁浸润采用患者自身对照法与手术病理所见进行对比,评价宫颈癌分期。结果MRI对宫旁浸润判断的准确度为94%,特异度为96%,敏感度为90%。MRI对宫颈癌总的分期预测的准确性为75.7%。在局限性和宫旁浸润的区分中MRI有着94%的准确性。结论MRI在宫颈癌中对区分局限性和浸润性病灶有着较高的准确性。引入MRI技术于临床,有利于治疗计划的制定,应成为宫颈癌术前常规的影像检查方法。     

磁共振成像检查对早期宫颈癌分期价值研究

目的探讨磁共振成像(MRI)在评估早期宫颈癌患者宫旁浸润、阴道受侵、淋巴结转移方面的价值。方法选取2010-10-01至2013-01-31辽宁省肿瘤医院收治的48例因宫颈癌为病因首次就诊患者,以术后病理结果为金标准比较MRI、术前妇科三合诊、术中探查和剖视标本3种诊断方法在宫旁浸润、阴道受侵、淋巴结转移3个方面的价值,并以手术-病理分期为金标准对MRI分期及术前临床分期的准确度进行对比。结果 MRI在早期宫颈癌术前淋巴结转移诊断方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为65%、94%、85%、83%、83%,在宫旁浸润方面分别为50%、91%、33%、95%、88%,在阴道受侵方面分别为50%、78%、43%、82%、71%。妇科三合诊在早期宫颈癌宫旁浸润方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为0、100%、0、92%、92%、阴道受侵方面分别为75%、100%、100%、92%、94%。临床分期的整体准确度为81%,MRI分期的整体准确度为67%,临床-MRI分期的整体准确度为92%。结论 MRI在早期宫颈癌术前淋巴结转移诊断方面有良好的价值;在宫旁浸润、阴道受侵方面有较好的阴性预测值和特异度;将临床-MRI结合所得分期较单独运用两种诊断方法分期准确度有所提高。     

宫颈鳞癌临床分期和淋巴结转移高危因素分析

目的:分析宫颈鳞癌临床分期的准确性、淋巴结转移规律及与各临床病理因素的相关性,探讨淋巴结转移的高危因素及术前临床分期存在的问题和补充改进方法。方法:收集我院行根治性子宫切除+盆腔淋巴结清扫术508例临床ⅠA～ⅡB期宫颈鳞癌患者的临床病理资料,比较临床分期与手术-病理分期(pTNM)的结果,并分析临床病理因素与淋巴结转移之间的关系。结果:临床分期总的准确率为60.2%。单因素分析显示间质浸润深度、淋巴血管间隙浸润(LVSI)、临床分期、宫旁浸润、切缘浸润、阴道浸润、宫体浸润与淋巴结转移相关(P<0.05);多因素分析提示仅间质浸润深度、LVSI、临床分期与淋巴结转移相关(P<0.05)。结论:宫颈鳞癌临床分期的准确性欠佳,应用影像学检查(如MRI)等可能有助于提高分期准确率。间质浸润深度、LVSI、临床分期与淋巴结转移密切相关。     

核磁共振联合阴道彩超评估早期子宫颈癌病情的价值初探

目的:探讨核磁共振成像(MRI)联合阴道彩色多普勒超声(TVUS)预测早期宫颈癌预后高危因素的价值。方法:选择2008年9月至2013年1月在北京大学人民医院住院的临床分期为ⅠB和ⅡA期、术前未接受其他治疗并具有完整影像学检查资料的78例患者,患者术前均行核磁共振常规及加权成像(MRI+DWI)和TVUS检查,回顾分析影像学检查结果与术后病理的关系。结果:MRI、TVUS、MRI联合TVUS判断肿瘤直径、阴道浸润、宫旁组织受侵及淋巴结转移与术后病理的一致性均较高,均无统计学差异(P均≥0.05);判断宫颈间质浸润深度与术后病理的一致性较低,具有统计学差异(MRI组:P=0.007;TVUS组:P=0.010;MRI联合TVUS组:P=0.002);预测肿瘤直径、宫颈间质浸润、阴道浸润、宫旁浸润、淋巴结受累中的准确率:MRI分别为81.8%、73.7%、84.6%、94.9%、78.2%;TVUS分别为66.7%、51.3%、78.2%、96.1%、82.0%;MRI联合TVUS分别为84.4%、78.2%、89.7%、97.4%、92.3%。结论:术前MRI联合TVUS检查对预测早期宫颈癌可能出现的影响预后的高危因素有重要价值,可提高术前病情评估的准确度,为选择最佳治疗方案提供参考。     

宫颈癌患者脉管内癌栓浸润与其他临床病理因素的相关性分析

目的：分析宫颈脉管内癌栓浸润（lymph-vascular space invasion,LVSI）与宫颈癌其他临床病理因素的关系,为指导宫颈癌治疗提供依据。方法：回顾性分析2003年4月—2013年5月上海市第一妇婴保健院收治的462例宫颈癌患者的临床及病理资料,其中LVSI阳性者185例（40%）,阴性者277例（60%）,对LVSI与肿瘤分期、淋巴结转移及其他临床、病理因素的关系进行相关性分析。结果：单因素分析显示宫颈癌患者LVSI的发生与肿瘤分期、肿瘤大小、浸润深度、淋巴结转移、是否术前经过新辅助治疗有关,而与采用何种新辅助治疗方法无关。LVSI与宫颈癌的其他5项高危因素,即组织病理学类型、间质浸润深度、肿瘤体积、宫旁浸润、淋巴结转移有关;且合并的高危因素越多,LVSI的发生率越高。结论：LVSI与其他病理高危因素密切相关,可能更早地提示淋巴结转移等其他高危因素的潜在风险,对指导宫颈癌的治疗意义重大。     

磁共振成像与术中病灶探查诊断子宫内膜癌肌层浸润及盆腹腔淋巴结转移临床价值研究

目的探讨磁共振成像(MRI)和术中病灶探查在子宫内膜癌肌层浸润及盆腹腔淋巴结转移诊断中的临床应用价值。方法回顾性分析上海交通大学附属第九人民医院2010年1月至2014年3月收治的33例行全子宫+双侧附件切除术+盆腔及腹主动脉旁淋巴清扫术的子宫内膜癌患者临床资料,以手术病理诊断为标准,比较术前MRI检查、术中病灶探查在诊断肿瘤侵犯子宫肌层深度和淋巴结转移的符合率。结果 MRI检查发现有肌层浸润33例,其中浅肌层浸润8例,深肌层浸润25例;术中剖视子宫标本发现有肌层浸润33例,其中浅肌层浸润6例,深肌层浸润27例。术后病理结果浅肌层浸润6例,深肌层浸润27例。提示MRI诊断浅肌层浸润敏感度100.00%,特异度92.59%。诊断深肌层浸润敏感度92.59%,特异度100.00%;术中病灶剖视诊断深浅肌层浸润敏感度和特异度均为100.00%。33例患者中经病理组织学确诊,8例患者出现淋巴转移,其中仅有盆腔淋巴结转移4例,盆腔及腹主动脉旁淋巴结转移2例,仅有腹主动脉旁淋巴结转移2例;33例患者术前MRI检查提示2例淋巴结转移,漏诊6例,MRI诊断淋巴结转移的敏感度25%;病灶探查发现4例盆腔淋巴结肿大(病理证实2例阳性,2例阴性),2例腹主动脉旁淋巴结肿大(1例阳性,1例阴性)。3例患者因淋巴结转移分期升级,术后需要辅以化疗和(或)放疗。结论子宫内膜癌患者术前MRI检查对判断肌层浸润深度准确率较高,手术中子宫标本的剖视与病理组织学检查相同,具有重要价值;而MRI检查和术中淋巴结探查对判断子宫内膜癌患者淋巴结转移的意义不大。盆腔及腹主动脉旁(至肾静脉水平)淋巴清扫可以使手术病理分期更准确,为患者术后提供更合理的治疗指导。     

多层螺旋CT和磁共振成像在浸润性宫颈癌术前分期中的价值分析

目的 探讨多层螺旋CT(MSCT)、磁共振成像（MRI）在浸润性宫颈癌术前分期的临床价值。方法 选取60例浸润性宫颈癌患者为研究对象,患者均行MSCT、MRI进行检查,其中病理学诊断结果作为浸润性宫颈癌检查的金标准,比较MSCT、MRI对术前分期的诊断符合率,并分析其图像表现。结果 MRI诊断阴道浸润准确率高于MSCT,而MSCT诊断子宫体侵犯、盆腔淋巴结转移的准确率高于MRI(P<0.05);经术后病理分期确诊,A期20例,B期28例,C期12例;分析MSCT的图像表现,可见宫颈有不同程度的增大,宫旁可见增粗的条索状影,病灶范围可见超过子宫颈间质环。大部分患者输尿管末段均显示模糊的脂肪间隙,且盆壁被侵犯。部分患者直肠、膀胱受到侵犯,扫描可见直肠、膀胱增厚;脏器壁厚度增加,不均匀,肿瘤向直肠突出;部分淋巴结转移患者,可见淋巴结增大,且边缘不清晰;增强扫描时,可见病灶中心有低密度区。分析MRI的图像表现,可见T2WI序列扫描时有不规则肿块、稍高信号,与正常宫颈相比,病灶区域呈等信号,且界限模糊;B期患者可见累及宫颈外,同时可见低信号基质环被中断,突出部分显示中等高信号;周围脂肪间隙...     

ⅠB～ⅡB期宫颈癌盆腔淋巴结转移的影响因素分析

目的：探讨ⅠB～ⅡB期宫颈癌盆腔淋巴结转移的影响因素。方法：回顾性分析630例行手术治疗的ⅠB～ⅡB期宫颈癌患者的临床资料,了解盆腔淋巴结的转移情况,采用χ2检验、Mann-Whitney U检验和多因素Logistic回归对宫颈癌盆腔淋巴结转移影响因素进行分析。结果：总体盆腔淋巴结转移率为27.9%（176/630）,转移淋巴结754枚,其中74.8%（564/754）分布于宫旁/闭孔区。单因素分析表明,临床分期、细胞分化、宫体受累、脉管间隙受累、宫颈间质浸润深度、鳞状细胞癌抗原（SCC-Ag）和癌抗原125（CA125）水平与盆腔淋巴结转移相关（均P＜0.05）。多因素分析表明,低细胞分化（OR=3.874,95%CI：1.100～13.646,P=0.035）、深1/3宫颈间质浸润（OR=2.735,95%CI：1.675～4.466,P＜0.001）和脉管间隙受累（OR=73.822,95%CI：22.304～244.336,P＜0.001）是盆腔淋巴结转移的独立危险因素。结论：宫颈癌盆腔淋巴结转移以宫旁/闭孔区最易受累,低细胞分化、深宫颈间质浸润、脉管间隙受累发生盆腔淋巴结转移风险较高,在临床治疗中,应确保宫旁切除范围,并实施系统性淋巴结清扫。     

Ⅰ～ⅡA2期宫颈癌淋巴结转移高危因素及对预后的影响

目的探讨宫颈癌盆腔淋巴结转移的高危因素及对预后的影响,提高生存率。方法回顾分析1995年1月至2011年6月在首都医科大学附属北京妇产医院经根治性手术治疗550例Ⅰ~ⅡA2期宫颈癌,盆腔淋巴结转移的相关危险因素及预后。结果 64例宫颈癌有盆腔淋巴结转移,无淋巴结转移者5年生存率92.2%,有转移者5年生存率51.6%(P0.05)。单因素分析,淋巴结转移与临床分期、组织学分级、肿瘤最大径线、宫颈深间质浸润、宫旁浸润、脉管间隙浸润相关(P0.05);宫旁组织浸润、转移淋巴结部位、阴道切缘状况、转移淋巴结数量、转移淋巴结组数,是有盆腔淋巴结转移宫颈癌预后的重要因素(P0.05)。多因素分析宫颈深间质浸润(P=0.001)和脉管间隙浸润(P=0.000)是影响宫颈癌淋巴结转移的独立危险因素;转移淋巴结组数2(P=0.000)是影响有淋巴结转移宫颈癌预后的独立危险因素。结论宫颈深间质浸润、脉管间隙浸润是影响宫颈癌盆腔淋巴结转移的独立高危因素;转移淋巴结组数≥2是有淋巴结转移宫颈癌影响预后的独立危险因素。     

磁共振成像在宫颈癌分期中的应用

宫颈癌筛查工作的开展使其病死率下降。但近年宫颈癌发病率呈稳步上升和年轻化趋势,提高宫颈癌临床诊治水平仍需进一步探讨和解决。宫颈癌正确分期对制定合理治疗方案、判断预后起重要作用。2009年国际妇产科联盟（FIGO）重新修订子宫颈癌分期,细化其中一些概念,但单纯应用临床术前分期仍有难以明确的问题。影像学检查在宫颈癌诊断中广泛应用,特别是磁共振成像（MRI）技术的应用更为临床提供了准确信息,凸显出MRI宫颈癌分期联合临床FIGO分期的重要性。MRI有直观显示肿瘤的优势,可准确评估宫颈间质浸润的深度、肿瘤体积及淋巴结转移情况等,是宫颈癌分期的重要影像学方法。     

子宫颈鳞癌Ⅰb～Ⅱa期患者预后预测系统的建立及其临床意义

目的分析子宫颈鳞癌Ⅰb~Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用。方法回顾性分析接受手术治疗的306例Ⅰb~Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析。结果306例患者的5年生存率为78 1%。单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0 05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0 05)。根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90 3%、83 9%和43 1%。低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2 2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13 5%,远处转移的发生率为1 3%, 局部复发合并远处转移的发生率为0 6%;高危组(淋巴结转移或合并其他危险因素)局部复发和远处转移的发生率分别为25 9%和48 3%,局部复发合并远处转移的发生率为10 3%。结论淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb~Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗。     

磁共振成像在子宫内膜癌FIGO2009新分期改动中的应用及误判分析

目的 评估增强磁共振成像（MRI）对子宫内膜癌肌层和宫颈浸润及盆腔淋巴结转移的诊断价值并分析误判的相关因素。方法 收集2009年3月至2013年3月天津医科大学总医院妇科收治的167例子宫内膜癌患者临床、增强MRI及病理资料进行回顾,将MRI分期与病理分期结果进行对照,并对肌层和宫颈浸润深度及淋巴结转移误判的相关因素进行分析。结果 （1）MRI诊断准确率随期别升高而降低,随子宫内膜样腺癌分化程度的降低而降低,差异有统计学意义（P<0.05）;MRI诊断子宫内膜样腺癌和特殊病理类型患者的准确率为79.74%和64.29%,差异有统计学意义(P<0.05)。（2）MRI诊断肿瘤浅肌层浸润的敏感度、特异度、准确率、阳性预测值（PPV）、阴性预测值（NPV）及与病理结果一致性的手捣直鹞?91.79%、90.91%、91.62%、97.62%、73.17%和0.758;深肌层浸润率分别为90.91%、91.79%、91.62%、73.17%、97.62%和0.758;宫颈浸润率分别为84.21%、95.95%、94.61%、72.73%、97.93%和0.750;盆腔淋巴结转移率分别为45.00%、91.16%、85.63%、40.91%、92.41%和0.347。（3）MRI错误评估肌层浸润、宫颈浸润及盆腔淋巴结转移,与患者分娩次数少、合并肌瘤、宫角部位病变、深肌层浸润、肿瘤体积大（包括肿瘤占宫腔面积≥1/2及肿瘤最大径较大）、子宫内膜样腺癌低分化及特殊病理类型正相关（P<0.05）。结论 增强MRI对术前子宫内膜癌深肌层浸润、宫颈浸润和盆腔淋巴结转移评估具有较高的准确率和阴性预测值。当患者合并肌瘤、宫角部位病变、肿瘤体积较大、特殊病理类型和子宫内膜样腺癌低分化等因素时较易误诊。     

Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy

BACKGROUND: The aim of this study was to identify the independent histopathologic prognostic factors for patients with cervical carcinoma treated with radical hysterectomy including paraaortic lymphadenectomy. METHODS: A total of 187 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy were retrospectively analyzed. The median follow-up period was 83 months. Cox regression analysis was used to select independent prognostic factors. RESULTS: Using multivariate Cox regression analysis, lymph node (LN) status (negative vs. metastasis to pelvic nodes except for common iliac nodes vs. common iliac/paraaortic node metastasis), histopathologic parametrial invasion, lymph-vascular space invasion (LVSI), and histology of pure adenocarcinoma were found to be independently related to patients' poor survival. For patients who had a tumor histologically confined to the uterus and have neither parametrial invasion nor lymph node metastasis, LVSI was the most important prognostic factor, and histologic type, depth of cervical stromal invasion, and tumor size were not related to survival. The survival of patients with a tumor extending to parametrium or pelvic lymph node(s) was adversely affected by histology of pure adenocarcinoma. When the tumor extended to common iliac or paraaortic nodes, patients' survival became quite poor irrespective of LVSI or histologic type of pure adenocarcinoma. Patients' prognosis could be stratified into low risk (patients with a tumor confined to the uterus not associated with LVSI: n = 80), intermediate risk (patients with a tumor confined to the uterus associated with positive LVSI, and patients with squamous/adenosquamous carcinoma associated with pelvic lymph node metastasis or parametrial invasion: n = 86), and high risk (patients with pure adenocarcinoma associated with pelvic lymph node metastasis or parametrial invasion, and patients with common iliac/paraaortic node metastasis: n = 21) with an estimated 5-year survival rate of 100 +/- 0 (mean +/- SE)%, 85.5 +/- 3.9%, and 25.1 +/- 9.7%, respectively. CONCLUSIONS: LN status, parametrial invasion, LVSI, and histology of pure adenocarcinoma are important histopathologic prognostic factors of cervical carcinoma treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Prognosis for patients with cervical carcinoma may be stratified by combined analysis of these histopathologic prognostic factors. Postoperative therapy needs to be individualized according to these prognostic factors and validated for its efficacy using randomized clinical trials.     

新辅助化疗在宫颈癌治疗中的应用及疗效观察

目的探讨术前新辅助化疗对局部晚期宫颈癌的治疗效果。方法对55例Ib2～Ⅱb期的宫颈癌患者行新辅助化疗，并对治疗效果进行评价。以同期未行新辅助化疗的33例宫颈癌患者作为对照，比较两组患者术中出血量、宫旁浸润率、阴道切缘阳性率及淋巴结转移率的差异。对患者进行随访，分析新辅助化疗对远期预后的影响。结果新辅助化疗组总有效率为94．6％，病理完全缓解者5例（9．1％）。有效的52例患者接受了手术。新辅助化疗组淋巴结转移率为36．5％，对照组为48．5％，两组比较，无差异（P〉0．05）。但新辅助化疗组中Ⅱ期患者淋巴结转移率（35．3％）低于对照组（69．2％），两者比较，差异有显著性（P〈0．05）。两组的宫旁浸润率分别为1．9％和18．2％，经精确概率法计算，两者比较，差异有显著性（P〈0．05）。术中出血量分别为（874．0±675．6）ml和（493．9±316．7）ml，两者比较，差异有显著性（P〈0．05）。NACT组与对照组的1年无瘤生存率分别为77．78％和81．04％，5年无瘤生存率分别为75．41％和81．04％，1年总生存率分别为93．91％和96．88％，5年总生存率分别为84．37％和88．03％，两组比较，差异均无显著性（P〉0．05）。结论新辅助化疗对局部晚期宫颈癌患者近期疗效显著，但对无瘤生存时间和总生存时间无明显影响。术后化疗、淋巴结转移是影响患者无瘤生存时间的主要因素。     

The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy

PURPOSE: This study was undertaken to evaluate the efficacy of postoperative radiotherapy (post-OP RT) and to investigate the prognostic factors for early-stage cervical cancer patients who were treated by radical surgery, and the pathological findings suggested a relatively high risk of relapse with surgery alone. MATERIALS AND METHODS: From January 1990 to December 1995, 222 patients with stage IB-IIA cervical cancer, treated by radical surgery and a full course of post-OP RT, were included in this study. The indications for post-OP RT were based on pathological findings, including lymph node metastasis, positive surgical margins, parametrial extension, lymphovascular permeation, and invasion of more than two-thirds of the cervical wall thickness. The radiation dose of external beam was 44-45 Gy to the whole pelvis and 50-54 Gy to the true pelvis. One hundred seventy-two patients also received intravaginal brachytherapy as a local boost. The minimal follow-up period was 2 years. RESULTS: The actuarial 5-year overall and disease-specific survival rates for all patients were 76 and 82%, respectively. The tumor control rate within the pelvis reached 94%, and distant metastasis was the major cause of treatment failure. Univariate analysis of clinical and pathological parameters revealed that clinical stage, bulky tumor size, positive lymph nodes, parametrial extension, and histologic type were significant prognostic factors. After multivariate analysis, only positive lymph nodes (P = 0.01), bulky tumor size (P = 0.02), and parametrial extension (P = 0.05) independently influenced the disease-specific survival (DSS). For patients with lymph node metastasis, the number and location of the nodal involvement significantly affected the prognosis. The 5-year DSS for patients with no, one, and more than one lymph node metastasis were 87, 84, and 61% (P = 0.0001), respectively. Patients with upper pelvic lymph node metastasis had a higher incidence of distant metastasis (50% vs 16% in lower pelvic node group, P = 0.03). In the subgroup of single lower pelvic nodal metastasis, the prognosis was similar to that of patients without lymph node involvement (5-year DSS 85% vs 87%, P = 0.71). CONCLUSION: Our results indicate that post-OP RT can achieve very good local control in stage IB-IIA cervical cancer patients whose pathological findings show risk features for relapse after radical surgery. The prognostic factors for treatment failure identified in this study can be used as selection criteria for clinical trials to test the effects of other adjuvant treatments, such as chemotherapy. Patients with a single lower pelvic lymph node metastasis have a relatively good prognosis and may not need adjuvant treatment beyond radiation therapy.     

The possible use of colour flow Doppler in planning treatment in early invasive carcinoma of the cervix.

OBJECTIVE: To investigate the pathological significance of intra-tumoural blood flow signals detected by colour Doppler ultrasound and their association with angiogenesis in cervical carcinoma. DESIGN: A prospective cross-sectional study. SETTING: University hospital. POPULATION: One hundred and four women with Stage IB-IIA cervical carcinoma. METHODS: All women underwent radical hysterectomy and pelvic lymph node dissection. Transvaginal colour Doppler ultrasound was performed before surgery to search for arterial blood flow signals within the tumours. Tumours with a measurable intra-tumoural resistance index were defined as tumour with detectable blood flow and the others as tumour with undetectable blood flow. The microvessel density of the excised tumour was assessed immunohistochemically. The women's clinical and pathologic data were recorded. RESULTS: There were 60 tumours (58%) exhibiting detectable intra-tumoural blood flow signals. Tumours with detectable blood flow were larger, had deeper cervical stromal invasion, a higher incidence of parametrial invasion and pelvic lymph node metastases, and a higher microvessel density, when compared with those without detectable blood flow. Cervical cancers with deep cervical stromal invasion, parametrial invasion, and pelvic lymph node metastasis had higher microvessel density than those with superficial stromal invasion, no parametrial invasion, or no lymph node metastasis. Microvessel density correlated well with lymph node metastases and parametrial invasion by multiple regression analysis, while intra-tumoural blood signals only showed correlation with parametrial invasion. In the prediction of pelvic lymph node metastases and parametrial invasion, colour flow Doppler had a sensitivity of 0.80 and specificity of 0.48 in predicting lymph node metastases, and sensitivity of 0.91 and specificity of 0.57 in predicting parametrial invasion. CONCLUSIONS: The characteristics of blood flow signals in cervical carcinoma detected by colour Doppler ultrasound are associated with tumour angiogenesis and could reflect the likelihood of parametrial invasion and lymph node metastases in cervical carcinoma. The intra-tumoural blood flow signals might be used as a screening test in predicting parametrial invasion and pelvic lymph node metastases. These findings may be helpful in planning treatment for women with Stage I and II cervical carcinoma.     

Value of preoperative serum CA125 in early-stage adenocarcinoma of the uterine cervix without pelvic lymph node metastasis

OBJECTIVE: This investigation attempted to clarify the value of preoperative serum CA125 in predicting histopathological prognostic factors for early-stage cervical adenocarcinoma without lymph node metastasis. METHODS: This study initially surveyed 163 patients with clinical stage Ib or IIa cervical adenocarcinoma treated with radical hysterectomy and pelvic lymphadenectomy. Of the 163 patients, 116 had preoperative serum CA125 levels, and 14 had pelvic lymph node metastasis. The investigation group comprised 102 lymph node-negative patients. RESULTS: A cutoff value of 26 U/ml was obtained after the discriminant function analysis for identifying patients with positive lymph vascular space invasion (LVSI) or depth of stromal invasion > or =2/3 thickness. Multivariate analysis revealed that among the preoperative clinicopathological variables, including age, tumor size, parametrial invasion, and CA125 level, raised CA125 most significantly influenced the assessment of the LVSI (P = 0.040) and depth of cervical stromal invasion (P = 0.002). CONCLUSIONS: In early-stage cervical adenocarcinoma with negative pelvic lymph node metastasis, preoperative serum CA125 levels at the cutoff value of 26 U/ml impacted the determination of the poor histopathological prognostic factors.     

早期宫颈鳞癌患者盆腔淋巴结转移的相关因素分析

目的:探讨早期宫颈鳞状细胞癌患者盆腔淋巴结转移的危险因素。方法:回顾分析152例行手术治疗的ⅠB~ⅡA期宫颈鳞癌患者的临床资料,分析患者的年龄、临床分期、肿瘤细胞分化程度、宫颈间质浸润深度、肿瘤直径大小、脉管癌栓、术前血清宫颈鳞状上皮抗原(SCC-Ag)水平、治疗前血浆纤维蛋白原(FⅠB)水平及D-二聚体水平9个指标与盆腔淋巴结转移的关系。结果:152例ⅠB~ⅡA期宫颈鳞癌患者中20例存在盆腔淋巴结转移(13.16%)。单因素分析结果显示,宫颈间质浸润深度、肿瘤直径、脉管癌栓、术前血清SCC-Ag水平及血浆FⅠB水平与盆腔淋巴结转移有关,差异有统计学意义(P0.05);淋巴结阳性患者的血浆D-二聚体水平高于阴性患者,但差异无统计学意义(P0.05)。多因素分析结果显示,脉管癌栓、术前血清SCC-Ag及血浆FⅠB水平与盆腔淋巴结转移相关,差异有统计学意义(P0.05)。结论:脉管癌栓、术前血清SCC-Ag水平及治疗前血浆FⅠB水平是ⅠB~ⅡA期宫颈鳞癌患者盆腔淋巴结转移的独立危险因素,而术前D-二聚体水平与盆腔淋巴结转移之间的关系,尚需进一步研究。     

A prospective surgical pathological study of stage I squamous carcinoma of the cervix: A Gynecologic Oncology Group study

Thirty-three institutions collaborating in the Gynecologic Oncology Group gathered surgical and pathological data on 1125 patients with primary, previously untreated, histologically confirmed stage I cervical carcinoma with more than 3 mm of invasion who were selected to undergo radical hysterectomy and paraaortic and pelvic lymphadenectomy. Of the 940 eligible, evaluable patients, 732 had squamous carcinoma. Of the study group, 87 (12%) did not undergo radical hysterectomy because of gross disease beyond the uterus or microscopic aortic node involvement documented at exploratory laparotomy. Among the 645 patients undergoing pelvic and paraaortic lymphadenectomy and radical hysterectomy, five risk factors were significantly associated with microscopic pelvic lymph node metastasis: depth of invasion (P = 0.0001), parametrial involvement (P = 0.0001), capillary-lymphatic space invasion (P = 0.0001), tumor grade (P = 0.01), and gross versus occult primary tumor (P = 0.009). The factors identified as independent risk factors for pelvic lymph node metastasis by multivariate analysis were capillary-lymphatic space involvement (P less than 0.0001), depth of invasion (P less than 0.0001), parametrial involvement (P = 0.0005), and age (P = 0.02). The model was used to predict the chance of a patient having nodal metastasis for any combination of risk factors.     

Preoperative serum SCC,CA125, and CA19-9 levels and lymph node status in squamous cell carcinoma of the uterine cervix

BACKGROUND: We wanted to investigate the clinical usefulness of determining the pretreatment levels of multiple serum tumor markers in predicting lymph node status and the prognosis for patients with cervical carcinoma. METHODS: The preoperative serum levels of squamous cell carcinoma antigen (SCC), cancer antigens CA125 and CA19-9 were assayed simultaneously in 103 patients with stages IB to IIB cervical SCC undergoing radical hysterectomy. The cut-off values of SCC, CA125, and CA19-9 in this study were 1.5 ng/ml, 35 U/ml, and 37 U/ml, respectively. The relation between preoperative tumor marker levels and histopathologic prognostic factors including lymph node metastasis and patient survival was studied. RESULTS: Preoperative serum SCC, CA125, and CA19-9 levels were significantly related to the FIGO stage. In addition, serum SCC and CA125 levels were significantly related to tumor diameter, depth of cervical stromal invasion, lymph-vascular space invasion, and lymph node metastasis. We subsequently created a double-tumor-marker (DTM) index, which incorporated the number of positive markers of SCC and CA125. The DTM index was strongly related to the number of positive pelvic lymph nodes (p = 0.0002) and to the site of positive nodes (none vs. pelvic only vs. common iliac/paraaortic) (p = 0.0005). Probability of lymph node metastasis according to the DTM index = 0, 1, and 2 was 6/48 (12.5%), 14/45 (31.1%), and 8/10 (80.0%), respectively. The rate of common iliac/paraaortic node metastasis according to the DTM index = 0, 1, and 2 was 1/48 (2.1%), 2/45 (4.4%), and 3/10 (30.0%), respectively. By logistic regression analysis, it was shown that the DTM index and tumor diameter were independently related to lymph node metastasis. Using multivariate Cox regression analysis including singly determined serum SCC and CA125 levels, clinical stage (IB/IIA vs. IIB), tumor diameter ( 4 cm), parametrial invasion, lymph node metastasis, and the DTM index, the DTM index was found to be the most important prognostic factor (p = 0.0005). However, when the sites of positive nodes were included in the multivariate analysis, only the sites of positive nodes (p = 0.0008) and parametrial invasion (p = 0.041) showed independent prognostic significance. CONCLUSION: Combination assay of pretreatment serum SCC and CA125 levels seems to be useful in estimating lymph node status and the prognosis for patients with cervical SCC in a preoperative setting.