Significance of the Absolute Number and Ratio of Metastatic Lymph Nodes in Predicting Postoperative Survival for the International Federation of Gynecology and Obstetrics Stage IA2 to IIA Cervical Cancer
Significance of the Absolute Number and Ratio of Metastatic Lymph Nodes in Predicting Postoperative Survival for the International Federation of Gynecology and Obstetrics Stage IA2 to IIA Cervical Cancer
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DOI：
10.1097/igc.0b013e3182778bcf
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发表时间：
2013-01-01
影响因子：
4.8
通讯作者：
Hao, Quan
中科院分区：
文献类型：
--
作者：
Chen, Ying;Zhang, Lei;Hao, Quan
目的：本研究旨在评估国际妇产科联盟IA 2至IIA期宫颈癌患者行根治性子宫切除术和盆腔淋巴结清扫术（RHPL）后，转移淋巴结与已清除淋巴结的比率（RPL）和转移淋巴结数量（MLN）在预测术后生存率方面的作用。回顾性分析2000 ~ 2006年120例宫颈癌行RHPL治疗的淋巴结转移患者的预后指标结果：588例接受RHPL治疗的宫颈癌患者中，120例有淋巴结转移者的5年生存率（YSR）明显低于468例无淋巴结转移者（22.4%vs84.4%，P < 0.001）。通过临界点生存分析，RPL临界值设计为10%，5-YSR分别为42.9%和11.8%，MLN计数临界值设计为1和5，5-YSR分别为62.5%、20.8%和7.8%。单因素分析显示，RPL和MLN计数增加与宫颈癌淋巴结转移患者的生存率降低相关。在多变量考克斯比例风险模型中，分期、组织学分级、RPL和MLN计数是影响生存率的重要独立预后因素。RPL的危险比（3.195）高于MLN计数的危险比（1.578），表明RPL对IA 2 ~ IIA型宫颈癌RHPL术后患者的预后评价上级优于MLN计数。结论：RPL和MLN计数可作为宫颈癌RHPL术后淋巴结转移的独立预后指标。比较RPL和MLN计数在预测宫颈癌患者生存方面的优势值得进一步研究。
Purpose: This study aimed to evaluate the ratio of metastatic and removed lymph nodes (RPL) and the number of metastatic lymph nodes (MLNs) in predicting postoperative survival for International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer after radical hysterectomy and pelvic lymphadenectomy (RHPL).Methods: A retrospective study was conducted in which 120 patients with lymph node metastasis who underwent RHPL for cervical cancer from 2000 to 2006 was analyzed to identify the prognostic indicators by using Kaplan-Meier and Cox proportional hazard methods.Results: Of 588 patients with cervical cancer who underwent RHPL, the 5-year survival rate (YSR) of 120 with lymph node metastasis was much lower than that of 468 without lymph node metastasis (22.4% vs 84.4%, P < 0.001). By cut-point survival analysis, RPL cutoff was designed as 10%, with the 5-YSR of 42.9% and 11.8%, and MLN count cutoffs were designed as 1 and 5, with the 5-YSR of 62.5%, 20.8%, and 7.8%, respectively. With univariate analysis, increasing RPL and MLN counts were associated with a poorer survival in women with node metastasis cervical cancers. Stage, histologic grade, RPL, and MLN count were significant independent prognostic factors for survival in a multivariate Cox proportional hazard model. In addition, RPL was verified superior to MLN count in prognostic evaluation for patients with IA2 to IIA cervical cancer after RHPL because the hazard ratio of RPL (3.195) was higher than that of MLN count (1.578).Conclusions: The RPL and MLN count may be used as the independent prognostic parameters in patients with cervical cancer with lymph node metastasis after RHPL. Comparison of the superiority of RPL and MLN count for better predicting the survival of patients with cervical cancer deserves to be investigated further.