局部晚期宫颈癌100例淋巴结转移特点及临床分析

目的：探索局部晚期（ⅠB2/ⅡA2期）宫颈癌的淋巴结转移特点及新辅助化疗对预后及并发症发生率的影响。方法：回顾性分析2008年1月-2016年12月南京医科大学第一附属医院收治的424例ⅠA2～ⅡA2期宫颈鳞癌或腺癌患者的临床资料，随访每位患者的生存情况，比较局部晚期宫颈癌患者淋巴结转移情况及新辅助化疗和直接手术患者在手术并发症及预后方面的差异。结果：共424例宫颈癌患者纳入研究，100例局部晚期宫颈癌患者中有68例直接行根治性手术治疗，32例先行1～2次介入或静脉新辅助化疗后行宫颈癌根治术，术后病理提示盆腔淋巴结转移者20例，没有发现腹主动脉旁淋巴结转移。单因素分析提示深肌层浸润、淋巴脉管间隙浸润（lymph vascular space invasion，LVSI）与淋巴结转移相关（P＜0.05）；组织学类型、分化程度、是否行新辅助化疗与淋巴结转移无关（P＞0.05）。将有统计学意义的单因素进行Logistic回归分析显示，LVSI为淋巴结转移的独立危险因素（P＜0.05）。新辅助化疗组淋巴结转移率为22.2％，手术组则为17.2％，2组比较差异无统计学意义（P＞0.05）。总生存期及无瘤生存期方面，局部晚期宫颈癌明显低于早期者。新辅助化疗组的术后感染发生率较低，手术时间和腹腔引流管留置时间较短，但2组差异无统计学意义（P＞0.05），而术中输尿管支架置入率、输血率、其他相邻脏器损伤的发生率2组相似。结论：局部晚期宫颈癌预后较早期差，淋巴结转移率明显高于早期，盆腔淋巴结转移主要与LVSI及深肌层浸润有关。新辅助化疗对局部晚期宫颈癌的影响尚不明确，也没有证据证明新辅助化疗影响盆腔淋巴结转移的检出率，在手术相关并发症的发生率方面还需更大样本或多中心的研究。

Characteristics of Lymphatic Metastasis and Clinical Analysis of 100 Patients with Locally Advanced Cervical Cancer

Objective：To investigate the characteristics of lymphatic metastasis of locally advanced cervical cancer (LACC) and to evaluate prognostic significance of neoadjuvant chemotherapy (NACT) in patients with LACC (FIGO IB2/IIA2). Methods: Retrospectively analyze the clinical records and follow-up information of 424 patients with cervical cancer or adenocarcinoma (FIGO IA2-IIA2) after radical hysterectomy in Department of Gynecology, Jiangsu Provincial People′s Hospital From January 2008 to December 2016. Results: In total, 424 patients with cervical cancer were enrolled in the study. Of the 100 patients with LACC, 68 patients underwent direct radical surgery, and 32 patients underwent radical cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. pelvic lymph node metastasis in 20 cases, and paraaortic lymph node metastasis was not found. Univariate analysis revealed that deep muscular layer invasion and lymph vascular space invasion (LVSI) was associated with lymph node metastasis (P＜0.05). Histological type, degree of differentiation and whether neoadjuvant chemotherapy were not associated with lymph node metastasis (P＞0.05). Statistically significant single factor Logistic regression analysis showed that LVSI was an independent risk factor for lymph node metastasis (P＜0.05). There was no significant difference of lymphatic metastasis rate between NACT group and RS group (22.2% vs. 17.2%, P＞0.05). The disease-free survival and overall survival of the LACC group were significantly lower than those of the early cervical cancer group. The NACT group has lower postoperative infection rate, shorter operating duration and less time to keep the abdominal drainage, but there was no statistic significance between the two groups (P＞0.05), and intraoperative ureteral stenting rate, blood transfusion rate and incidence of other adjacent organ injuries were similar in the 2 groups. Conclusions: Locally advanced cervical cancer has poorer prognosis with significantly higher lymphatic metastasis rate than early cervical cancer. Pelvic lymph nodes metastasis was mainly correlated with LVSI and deep muscular layer involvement. Weather neoadjuvant chemotherapy infects the prognosis of advanced cervical cancer is unclear , and there is no evidence that neoadjuvant chemotherapy affects the detection rate of pelvic lymph node metastases. A larger sample or multicenter study is needed in the incidence of surgical-related complications.