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术前临床ⅠB1期子宫颈癌患者术后盆腔淋巴结转移的危险因素及预后分析
苏克, 张也, 蔡玉洁, 张筱筱, 郭瑞霞
中国实用妇科与产科杂志 ›› 2026, Vol. 42 ›› Issue (7) : 732-735.
PDF(982 KB)
PDF(982 KB)
术前临床ⅠB1期子宫颈癌患者术后盆腔淋巴结转移的危险因素及预后分析
Risk factors and prognostic analysis of postoperative pelvic lymph node metastasis in stageⅠB1 cervical cancer
目的 探讨术前临床诊断为国际妇产科联盟（FIGO）ⅠB1期子宫颈癌的患者术后发生盆腔淋巴结转移的危险因素以及淋巴结转移对无病生存率的影响。方法 收集2017年1月至2022年12月于郑州大学第一附属医院接受诊疗的318例术前临床FIGOⅠB1期子宫颈癌患者临床资料，开展回顾性研究。使用单因素和多因素logistic回归分析盆腔淋巴结转移的危险因素，通过Kaplan-Meier生存曲线对比淋巴结转移组与无转移组的患者生存率差异。结果 318例患者中，淋巴结转移21例（6.6%），中位随访时间是61个月。单因素分析显示子宫颈间质浸润深度、淋巴脉管间隙浸润（LVSI）以及鳞状细胞癌抗原（SCCA）异常升高与盆腔淋巴结转移存在相关性 （P<0.05）；多因素logistic回归分析证实LVSI是ⅠB1期子宫颈癌盆腔淋巴结转移的独立危险因素（P<0.05）。Kaplan-Meier生存曲线结果显示，淋巴结转移组的患者生存率明显劣于无淋巴结转移组（P<0.01）。结论 LVSI可作为早期子宫颈癌盆腔淋巴结转移的独立预测指标，一旦出现淋巴结转移，会明显缩短患者术后无病生存时间。
Objective To explore the risk factors for pelvic lymph node metastasis in patients with preoperatively diagnosed stage ⅠB1 cervical cancer and the effect of lymph node metastasis on disease-free survival. Methods A retrospective study was conducted on the clinical data of 318 patients with FIGO stage ⅠB1 cervical cancer, who were treated at the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2022. Univariate and multivariate logistic regression analyses were used to identify the risk factors for pelvic lymph node metastasis，and Kaplan-Meier survival curve was used to compare the difference in disease-free survival between the lymph node metastasis group and the no-metastasis group. Results Among the 318 patients enrolled in this study，21 （6.6%） had lymph node metastasis，with a median follow-up of 61 months. Univariate analysis showed that depth of cervical stromal invasion，lymphovascular space invasion （LVSI），and abnormally elevated squamous cell carcinoma antigen （SCCA） were associated with pelvic lymph node metastasis （P<0.05）. Multivariable logistic regression analysis revealed that LVSI was an independent risk factor （P<0.05）for pelvic lymph node metastasis in stage ⅠB1 cervical cancer. Kaplan-Meier survival analysis demonstrated that the disease-free survival was significantly poorer in the lymph node metastasis group than in the no-metastasis group （P<0.01）. Conclusion LVSI can be used as an independent predictive factor for pelvic lymph node metastasis in early-stage cervical cancer，and lymph node metastasis significantly reduces the disease-free survival of patients after surgery.
子宫颈癌 / 淋巴结转移 / 危险因素 / 预后 / 无病生存率
cervical cancer / lymph node metastasis / risk factor / prognosis / disease-free survival
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The purpose of this study was to evaluate the prognostic factors of patients with stage IIIC1r cervical cancer who underwent concurrent chemoradiotherapy.
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To assess the risk factors of lymph node metastasis (LNM) in patients with FIGO stage (2009) IB1 cervical cancer (CC).
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Pelvic lymphadenectomy, which is the routine surgical treatment for early-stage cervical cancer, causes serious morbidity. The goal of the current retrospective study was to identify predictive factors of lymph node metastasis (LNM) in patients with early-stage cervical cancer.The study included 496 patients diagnosed with stages IA2-IB1cervical cancer who underwent a radical hysterectomy with pelvic lymphadenectomy. The predictive factors of LNM were evaluated.The incidence of LNM in this study was 4.6%. LNM was more common in patients with deep stromal invasion (DSI), tumor size > 2 cm, lymph vascular invasion and parametrial involvement (PI). Multivariate analysis showed DSI (p = 0.010) and PI (p = 0.005) were independently associated with LNM. The median follow-up time was 56.9 months. The patients with LNM had poorer 5-year overall survival (77.8%; 95% confidence interval (CI) 44.2-92.6) than the patients without LNM (98.2%; 95% CI 95.6-99.2; p = 0.002) and also poorer 5-year recurrence-free survival (65.5%; 95% CI 38.6-82.8) than the patients without LNM (90.2%; 95% CI 86.5-92.9; p < 0.001).The predictive factors of pelvic lymph node metastasis in stage IA2-IB1 cervical cancer patients were DSI and PI. LNM was associated with poorer oncological outcomes.© 2018 S. Karger GmbH, Freiburg.
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The role of sentinel lymph node (SLN) biopsy alone for staging of early-stage cervical cancer remains controversial. We aimed to determine the validity of this technique in women with early-stage cervical cancer.We retrospectively reviewed women with early-stage cervical cancer who underwent SLN mapping followed by complete pelvic lymphadenectomy as part of initial surgical management from August 1997 through October 2015. All modes of surgical approach were included. Lymphatic mapping was performed using blue dye, technetium-99m sulfur colloid (Tc-99), and/or indocyanine green (ICG). We determined SLN detection rates, sensitivity and negative predictive value.One hundred eighty-eight patients were included, and 35 (19%) had lymph node metastases. At least one SLN was identified in 170 patients (90%), and bilateral SLNs were identified in 117 patients (62%). The majority of SLNs (83%) were found in the pelvis. There was no difference in detection rates between mapping agents, surgical approach, patients with and without prior conization or between patients with tumors <2cm and ≥2cm. The detection rate for bilateral SLNs was significantly lower in women with body mass index (BMI)>30kg/m than in women with lower BMI (p=0.03). Metastatic disease in sentinel nodes was detected by H&E staining in 78% of cases and required ultrastaging/immunohistochemistry in 22% of cases. Only one patient had a false-negative result, yielding a sensitivity of 96.4% (95% CI 79.8%-99.8%) and negative predictive value of 99.3% (95% CI 95.6%-100%). The false-negative rate was 3.6%.In these women with early-stage cervical cancer, SLN biopsy had very high sensitivity and negative predictive value. We believe it is time to change the standard of care for women with early-stage cervical cancer to SLN biopsy only.Copyright © 2017 Elsevier Inc. All rights reserved.
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To evaluate the clinical diagnostic validity of carbon nanoparticle suspension (CNS) in sentinel lymph node biopsy (SLNB) for assessing lymphatic spread of early‐stage cervical cancer.
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Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications following the removal of the sentinel lymph node remain unknown. Thus, this study aimed to evaluate the occurrence of lymphatic complications post sentinel node navigation surgery in patients with early cervical cancer.A total of 167 patients, including 70 and 97 patients who had undergone SNNS and pelvic lymphadenectomy (PLA), respectively, were enrolled in this study. We compared the lymphatic complications (lower extremity lymphedema and pelvic lymphocele) between the SNNS and PLA groups.The median number of sentinel lymph nodes removed was 2 (range: 1-14). Among the 70 patients in the SNNS group, there were 0 (0%) and 3 (4.3%) occurrences of lower extremity lymphedema and pelvic lymphocele, respectively. The occurrences of lower extremity lymphedema and pelvic lymphocele were significantly lower in the SNNS group than in the PLA group, despite circumflex iliac node removal.The occurrence of lymphatic complications (lower extremity lymphedema and pelvic lymphocele) was significantly lower in the SNNS group than in the PLA group. We found that SNNS, and not PLA, was the best treatment option for preventing the development of lower extremity lymphedema and pelvic lymphocele, despite circumflex iliac node preservation.© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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The purpose of this study was to evaluate the impact of high-risk factors on the survival of patients with cervical cancer treated with surgery followed by adjuvant chemoradiotherapy.From 2000 to 2014, medical records of 897 patients with International Federation of Gynecology and Obstetrics stage IB-IIA disease treated with surgery were retrospectively reviewed. Among them, 483 patients with high-risk factors, including pelvic lymph node metastasis, parametrial invasion, or resection margin involvement, were analyzed.The median follow-up time was 57 months (range, 6-205 months). For patients with single and multiple high-risk factors, the 5-year DFS rates were 80.4% and 65.7%, respectively (p < 0.001), and 5-year OS rates were 87.3% and 75.1%, respectively (p = 0.001). Distant metastasis was the most common pattern of recurrence (86.1%). Furthermore, distant metastasis-free survival significantly differed with the number of high-risk factors present (single 82.7% vs. multiple 68.8%, p < 0.001). In the multivariate analysis, while parametrial invasion and resection margin involvement showed no association, the adenocarcinoma histology, pelvic lymph node metastasis, higher metastatic lymph node ratio, and multiple high-risk factors were independent prognosticators associated with poor DFS and OS.Patients with early-stage cervical cancer having multiple high-risk factors, adenocarcinoma histologic type, and pelvic lymph node metastasis accompanied by a higher lymph node ratio after surgery are more likely to have occult distant metastasis. Further, consolidation with systemic chemotherapy after adjuvant therapy might be considered to improve the survival outcome in this patient population.Copyright © 2020. Published by Elsevier Inc.
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唐芃睿, 李源, 向阳. 循环肿瘤DNA液体活检技术在子宫颈癌随访监测中的研究现状与展望[J]. 中国实用妇科与产科杂志, 2025, 41(12):1245-1248. DOI:10.19538/j.fk2025120118.
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所有作者均声明不存在利益冲突
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