宫颈癌综合治疗后远处淋巴结转移临床分析

目的：探讨宫颈癌综合治疗后远处淋巴结复发转移的临床特征、治疗和预后。方法：对5例远处淋巴结转移的宫颈癌患者的临床资料进行分析。结果：5例患者接受手术、化疗或放疗等综合治疗，所有患者术前磁共振显像（MRI）／计算机断层扫描（CT）检查未发现远处转移，而于治疗结束后1个月～2年出现，其中4例发生腹主动脉旁淋巴结转移，2例合并左锁骨上淋巴结转移。经全身化疗及三维适形放疗，4例死亡，平均生存15．3个月．1例带瘤生存24个月。结论：腹主动脉旁及左锁骨上淋巴结转移可能是宫颈低分化癌患者远处复发转移部位之一，需要应用手术、化疗及放疗等综合治疗。正电子发射断层扫描（PET）／单光子发射扫描（SPECT）技术是诊断、随访及评价预后的重要工具。

Clinical Analysis of Distant Lymph Node Metastasis in Patients with Cervical Cancer after Combined Treatment

Objective: To investigate the clinical characteristics, treatment and prognosis for patients with cervical cancer with distant lymph node metastasis after combination therapy. Methods: Data of 5 patients with distant lymph node metastasis of cervical cancer, from January 2000 to January 2006, were analyzed retrospectively. Results: Of the 5 patients, cervical adenocarcinoma was confirmed in 1, poorly differentiated squamous cancer (SqCa) of the cervix was confirmed in 3 and moderately differentiated SqCa of the cervix was confirmed in 1. There was no evidence of distant lymph node metastasis before combined treatments according to the MRI/CT scans. However, remote lymph node metastases were seen 1 to 24 months after the combined treatment, including paraaortic lymph node metastasis shown in 4 cases and a complication of supraclavicular lymph node metastasis in 2 cases. Four patients died after systematic chemotherapy and local three-dimensional conformal radiotherapy, with a mean survival rate of 15.3 months. One patient with uncontrolled recurrence achieved a survival time of 24 months. Conclusion: Supraclavicular and paraaortic lymph node metastases are both distant lymph node metastasis sites for patients with poorly-differentiated cancer of the cervix. Surgery combined with chemo-radiotherapy is needed for treating the patients. Positron emission tomography (PET) or single photon emission computed tomography (SPECT) is useful for diagnosis, follow-up and prognosis of the disease.