卵巢癌腹主动脉旁淋巴结清除术与生存率的关系

目的:探讨上皮性卵巢癌患者行腹主动脉旁淋巴结清除术与其生存预后的关系。方法:回顾分析卵巢癌肿瘤细胞减灭术的80例患者,将其中行腹主动脉旁淋巴结(PAN)+盆腔淋巴结(PLN)清除术分为A组(30例),仅行PLN清除术者分为B组(50例),分析PAN清除与患者生存预后的相关性。结果:行卵巢肿瘤细胞减灭术的80例患者中,32例(40.0%)发生淋巴结转移。A组中19例发生淋巴结转移,其中仅PAN阳性7例,仅PLN阳性3例,PAN和PLN均阳性9例;B组中13例发生PLN转移。A与B组患者的淋巴结转移与临床分期、肿瘤细胞分化程度和组织学类型显著相关(P0.05)。A组中淋巴结转移部位以PAN最多16例,其余依次为髂内、闭孔、髂总、腹股沟及髂外淋巴结。A组患者的3年、5年生存率分别为77.9%和46.7%,均高于B组(69.0%和39.2%),但无显著差异(P0.05)。A与B组患者中转移至PLN者的3年生存率分别是68.5%和41.4%,5年生存率是49.7%和26.4%,两组比较差异显著(P=0.044)。A组患者中淋巴结阳性与阴性患者3年生存率分别为43.5%和72.7%,5年生存率是27.2%和58.5%,差异显著(P=0.048)。Cox模型单因素分析提示,淋巴结状态对患者的生存率有影响(P0.01),而且是死亡风险因素。结论:腹主动脉旁淋巴结的清除对改善卵巢癌患者预后起着重要作用。

The clinical significance of dissection of para-aortic lymph node and prognosis involvement in ovarian cancer.

Objective：To study the relationship between the paraaortic lymphadenectomy and prognosis in epithelial ovarian cancer. Methods：In this study, 80 patients were divided into groups A and B. Group A consisted of 30 patients who underwent PAN＋pelvic lymph node （PLN） dissection,whereas group B consisted of 50 patients who only underwent PLN dissection. Analysis of the correlation between PAN dessection and prognosis in epithelial ovarian cancer was conducted. Results： 19 cases of lymph node metastasis were found in group A, among whom 7 cases were positive for PAN, 3 cases for PLN, and 9 cases for both PAN and PLN. In group B, 13 cases were positive for lymph node metastasis. The metastatic rate of lymph node is 40.0%. Lymph node metastasis was significantly correlated with FIGO stage, tumor differentiation,and histological type both in groups A and B （P〈0.05）. In group A, 16 cases of lymph node metastatic sites to PAN were observed in group A, followed by internal iliac, obturator foramen, common iliac, external itiac and inguinal lymph nodes. In groups A and B, the three -year survival rates were 77.9% and 69.0% ,and the five-year survival rates were 46.7% and 39.2% ,respectively. However,the difference was not statistically significant （P〉0.05）. The three-year survival rates of PLN metastasis in groups A and B were 68.5 % and 41.4 %, and the five-year survival rates were 49.7% and 26.4%, respectively. Furthermore, PLN-positive patients who cleared PAN had significantly higher survival rate （ P = 0.044 ）. In group A, the three-year survival rates of positive and negative lymph nodes were 43.5% and 72.7%, and the five-year survival rates were 27.2 % and 58.5 %, respectively. The difference was statistically significant （P=0.048）. Cox model analysis of single factor suggested that lymph node status affected the survival rate （P〈0.01） ,which was the death risk factor. Conclusion：Para-aortic lymphadenectomy plays an important role in the clinical treatment and prognosis of patients with ovarian cancer.