Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer.
Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB-IIB cervical cancer.
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DOI：
10.3802/jgo.2018.29.e11
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发表时间：
2018-01
影响因子：
3.9
通讯作者：
Sugiyama T
中科院分区：
文献类型：
--
作者：
Matsuo K;Shimada M;Saito T;Takehara K;Tokunaga H;Watanabe Y;Todo Y;Morishige KI;Mikami M;Sugiyama T
旨在检查根治性子宫切除术中主动脉旁淋巴结（PAN）转移的手术病理学预测因素，以及根治性子宫切除术中未接受 PAN 切除的女性中 PAN 复发的手术病理学预测因素。这是对手术治疗的 IB-IIB 期宫颈癌 (n=5,620) 的全国范围队列研究的回顾性分析。使用多变量模型来确定 PAN 转移/复发的独立手术病理预测因素。手术时有 120 例（2.1%）PAN 转移，宫旁受累（调整比值比 [aOR]=1.65）、深部间质侵犯（aOR=2.61）、卵巢转移（aOR=3.10）和盆腔淋巴结转移（分别为单淋巴结 aOR=5.39 和多淋巴结 aOR=33.5）为独立危险因素（所有， p<0.05）。在没有任何危险因素的情况下，PAN 转移的发生率为 0.9%，而表现出某些危险因素模式的女性（> 研究人群的 20%）的 PAN 转移发生率≥4%。在 4,663 例临床 PAN 阴性手术病例中，195 例 (4.2%) 出现 PAN 复发，明显高于组织学 PAN 阴性病例 (2.5%，p=0.046)。在临床 PAN 阴性病例中，宫旁受累（调整后风险比 [aHR]=1.67）、淋巴血管间隙侵犯（aHR=1.95）、卵巢转移（aHR=2.60）和盆腔淋巴结转移（分别为单淋巴结 aHR=2.49 和多淋巴结 aHR=8.11）与 PAN 复发风险增加独立相关 （全部，p<0.05）。在没有任何危险因素的情况下，5年PAN复发风险为0.8%；然而，表现出某些危险因素模式的女性（临床 PAN 阴性人群的 15% 以上）的 5 年 PAN 复发风险≥8%。本研究中提出的手术病理风险因素将有助于识别 PAN 转移/复发风险增加的女性。
To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
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