宫颈鳞癌淋巴结转移特点、相关因素及预后分析

目的:阐明宫颈癌诸多临床病理生理因素与淋巴结转移的相关性,揭示宫颈癌淋巴结转移的规律及其对预后的影响,并针对具有不同淋巴结转移特点的宫颈癌患者制定个体化治疗方案。方法:回顾性分析中山大学肿瘤防治中心1993年12月~1996年12月收治的Ιa-Ⅱb期、以手术治疗为主的99例宫颈鳞癌患者的淋巴结转移特点、临床病理生理因素、预后及其相互关系。结果:①99例宫颈癌患者总体5年生存率60.6%,其中无淋巴结转移者5年生存率70.0%,有淋巴结转移者5年生存率36.7%。②较晚的临床分期,原发病灶大于或等于4 cm,病理分化程度较低者,有较高的淋巴结转移率,反之淋巴结转移率低。③宫颈癌单侧及单站淋巴结转移者预后好于双侧及多站淋巴结转移者;有髂总淋巴结转移者预后极差,单侧仅有闭孔淋巴结转移者5年生存率67.0%,与无淋巴结转移者相近(71.0%)。④宫颈癌闭孔淋巴结转移率最高,其它部位淋巴结转移者多合并有闭孔淋巴结转移。结论:①淋巴结转移是影响宫颈癌预后的重要因素。②临床分期、原发灶大小与宫颈癌淋巴结转移呈正相关,分化程度与淋巴结转移呈负相关。③闭孔淋巴结可能是宫颈癌的前哨淋巴结。④髂总淋巴结转移者,治疗应更积极、个体化,单侧闭孔淋巴结转移者,预后较好,或可免行术后补充治疗,而代之以密切随访。

The characteristics and relative factors of lymph nodes metastasis of cervical squamous cell cancer and its prognosis analysis

Objective:To investigate the relativity of several clinical and pathological parameters of cervical cancer and its lymph node metastasis,and to revealed the rule of lymph node metastasis,so as to make individual therapy methods according different parameters of lymph node metastasis.Methods:99 cases of cervical squamous cell cancer were analyzed retrospectively,which were treated by Cancer Center of Sun Yet-sen University from Dec 1993 to Dec 1996.These patients were all accepted radical surgery and(or) additional radiotherapy or chemotherapy.Results:The 5-year survival of 99 cases was 60.6%,in which the incidence of negative lymph node cases was 70.0%,but that of positive lymph node was 36.7%.Patients with late FIGO stage,lower differentiation and smaller tumor size had higher rate of lymph node metastasis,vice versa.Cases with single side or single stop positive lymph node had better prognosis that of double side or more than two stops positive lymph nodes.The prognosis of patients with positive common iliac lymph node was the worst.Further more,the 5-year survival rate of single side positive obturator lymph node was 67.0%,which was similar to that of cervical cancer with negative lymph node.The incidence of lymph node metastasis was the highest in obturator stop than any other stop.Conclusion:Lymph node metastasis is an important factor which affects the prognosis of cervical Squamous Cell Cancer.The rate of lymph node metastasis is positive related with the FIGO stage and tumor size,but is negative related with differentiation degree.Obturator lymph node may be the sentinel node.Patients with single side positive obturator lymph node have a preferable prognosis,and these patients needn't accept adjuvant therapy after radical surgery if they can be followed up closely.On the contrary,if a cervical Squamous Cell Cancer case has a positive common iliac lymph node,an adjuvant therapy may be a wisdom selection.