Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer
Distribution pattern of lymph node metastases and its implication in individualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer
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DOI：
10.1186/s13014-015-0352-5
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发表时间：
2015-02-15
影响因子：
3.6
通讯作者：
Wang, Xiang
中科院分区：
文献类型：
--
作者：
Li, Xinglan;Yin, Yueju;Wang, Xiang
背景：研究IA~IIA期宫颈癌淋巴结转移的分布规律，明确局部淋巴结个体化临床靶区勾画（CTVn）。方法：回顾性分析国际妇产科联合会IA~IIA期宫颈癌665例行根治性子宫切除术和盆腔淋巴结清扫术的病例。采用logistic回归分析与淋巴结转移相关的临床病理因素。结果：665例患者中，168例发现盆腔淋巴结转移，转移率为25.3%。二元逻辑回归分析显示，年龄、淋巴管间隙受累和深部间质浸润对盆腔淋巴结转移有统计学影响（分别为 p = 0.017、< 0.001、< 0.001）。病理形态类型、闭孔淋巴结转移、髂外、髂内、主动脉旁淋巴结转移对髂总淋巴结转移有较强影响（p分别为0.022、0.003、<0.001、0.009）。髂总的肿瘤大小和淋巴结转移与主动脉旁的淋巴结转移显着相关（分别为p = 0.045，< 0.001）。闭孔、髂外、髂内淋巴结转移与髂外淋巴结远端旋髂淋巴结转移密切相关（CINDEIN；分别p = 0.027、0.024）。结论：宫颈癌放疗CTVn的设计和定制应综合考虑淋巴结转移的相关因素。应进行选择性区域照射，包括相关的淋巴引流区域。
Background: To study the distribution pattern of lymph node metastases of stage IA to IIA cervical cancer and to clarify the individualized clinical target volume delineation of regional lymph nodes (CTVn).Methods: A total of 665 cases with International Federation Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The clinicopathological factors related to lymph node metastases were analyzed using logistic regression analysis.Results: Pelvic lymph node metastases were found in 168 of 665 patients resulting in a metastasis rate of 25.3%. Binary logistic regression analysis showed that age, lymph vascular space involvement, and deep stromal invasion statistically influenced pelvic lymph node metastases (p = 0.017, < 0.001, < 0.001, respectively). Pathological morphology type, lymph node metastases of the obturator, the external iliac and internal iliac, and the para-aortic had a strong influence on lymph node metastases of the common iliac (p = 0.022, 0.003, < 0.001, 0.009, respectively). Tumor size and lymph node metastases of the common iliac were significantly related to lymph node metastases of the para-aortic (p = 0.045, < 0.001, respectively). Lymph node metastases of the obturator, the external iliac and internal iliac were strongly correlated to lymph node metastases of the circumflex iliac node distal to the external iliac node (CINDEIN; p = 0.027, 0.024, respectively).Conclusions: Factors related to lymph node metastases should be comprehensively considered to design and tailor CTVn for radiotherapy of cervical cancer. Selective regional irradiation including the correlated lymphatic drainage regions should be performed.