The Clinical Analysis of Lymph Node Metastasis in Stage I,II Cervix Carcinoma
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Objective:To explore the features of pelvic lymph node metastasis,the related prognostic factors and the influence to outcome in stage Ⅰ,Ⅱcervical cancer patients.Methods:We retrospectively analyzed 32 cervical cancer patients with lymph node metastasis and 32 cases without lymph node metastasis,who had undertaken extensive hysterectomy and radical pelvic lymphoadenectomy.Results:The lymph node metastasis rate was 23.35%,and the most common metastasis of cervical carcinoma occurred at the obturator node(59.37%).Pelvic lymph node metastasis was associated with deep cervical stromal invasion,which was not correlated with age,histological classification,the grade of differentiation,parametrial involvement,and lymphovascular invasion.The relevant prognostic factor for cervical carcinoma was number of lymph node metastasis,and was not the depth of cervical stromal invasion,histological classification,the grade of differentiation and lymphovascular invasion.Conclusion:The stromal invasion ≥l/2 is a risk factor of pelric lymph node metastasis in cervical cancer.The prognosis of patients with ≥3 positive pelvic lymph node are quite poor,which is helpful for clinical therapy.Keywords:
Lymphovascular invasion
Parametrial
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Objective To study the clinical pathological characteristics of patients with cervix cancer, as well as the relationship between the pelvic lymph node metastasis, find out the risk factors of lymph node metastasis.Methods Through a retrospective analysis of our hospital from January 2010 to January 2010, 156 cases of cervical cancer patients with the clinical pathological data, the relationship between the analysis with the pelvic lymph node metastasis.Results 156 patients occurred in 41 cases of pelvic lymph node metastasis, the incidence was 26.28%.Conclusion Cervical cancer patients with pathological grade, clinical stage and tumor diameter, infiltrating depth are affect the risk factors of pelvic lymph node metastasis, during the radical surgery for cervical cancer patients should pay attention to the impact of these risk factors.
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Objective To evaluate correlation factors of cervical lymph nodes metastasis in thoracic esophageal carcinoma.Methods Local-regional metastasis of lymph node for 126 cases with esophageal squamous cell cancer after surgery from 2004 to 2009 were reviewed.Risk factors of cervical lymph nodes metastasis were examined by multiple Logistic regression analysis.Results In 126 cases,supraclavicular lymph node metastasis rate was 43.7％ (55/126).By logistic regression,none of the primary site,T stage,N stage,histological grade,lymph node metastasis rate,lymph node metastasis degree and number of lymph nodes metastatic field was not the high risk of cervical lymph nodes metastasis.In addition,multivariate analysis found that lymph node metastasis in mediastinum region 1 was high risk factor for lymph node metastasis of region 1 ( x2 =12.14,9.27,P =0.000,0.002),lymph node metastasis in region Ⅲ and region 2 were high risk factors for lymph node metastasis of region Ⅱa ( x2 =14.56,8.27,8.02,3.93,P =0.000,0.004,0.005,0.047 ).Conclusion Mediastinal para-recurrent nerve lymph node metastasis is a significant predictor for cervical lymph nodes metastasis.
Key words:
Esophageal neoplasms/surgery; Neoplasms meatstasis,neck lymph nodes; Neoplasms metastasis,para-recurrent nerve lymph node
Cervical lymph nodes
Supraclavicular lymph nodes
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Pelvic lymph node metastasis is an important prognostic factor of cervical carcinoma, but few have been reported on both risk factors and prognostic factors of node-positive cervical carcinoma. This study was to evaluate risk factors, distribution pattern, and prognosis of node-positive cervical carcinoma, and explore the forecast of lymph node metastasis and appropriate treatment.Clinical data of 205 cervical cancer patients who had undergone radical hysterectomy and bilateral pelvic lymphadenectomy were analyzed retrospectively.The overall prevalence of lymph node metastasis was 24.4% (50/205). Univariate analysis showed that risk factors of node metastasis were serum level of squamous cell carcinoma antigen (SCC-Ag) before treatment, clinical stage, invasive depth of cervical canal or vaginal portion of the cervix, and uterine ligaments involvement. SCC values exceeding 4 microg/L increased the risk of nodal metastasis by 4.2 folds (P<0.001, OR=4.212). Multivariate analysis showed that clinical stage and invasive depth of cervical canal were the major risk factors. The obturator and obturator fossae lymph nodes were the most frequently involved, with a rate of 48.0%. Moreover, 60.0% node-positive patients had multiple sites lymph node metastases, and saltatory metastasis was found. Lymph node metastasis was closely related to deep muscularis involvement of the cervix and parametrial involvement; 72.0% nodal metastases were accompanied with deep muscularis involvement of the cervix, 90.9% uterine ligament invasions were accompanied with lymph node metastasis. The 5-year survival rate was significantly higher in the patients received postoperative radiation than in the patients didn't receive radiation (89.1% vs. 45.5%, P=0.012).Serum level of SCC-Ag before treatment exceeding 4 microg/L, deep muscularis involvement of vaginal portion of the cervix, uterine ligaments involvement, especially advanced stage and deep muscularis involvement of the cervical canal, are risk factors of pelvic lymph node metastasis of cervical cancer. The standard type III radical hysterectomy and bilateral pelvic lymphadenectomy should be performed to the patients with high risk of lymph node metastasis to ensure enough amplitude of parametrectomy and excision of positive nodes. When lymph node metastasis is confirmed after surgery, postoperative radiation can improve the prognosis.
Parametrial
Univariate analysis
Lymphadenectomy
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Objective To analyze the principles and its clinical significance of pelvic lymph node metastasis in patients with stageⅠB2～ⅡAcervical cancer treated by sensitivity enhancement of radiotherapy.Methods Sixty-four patients with stageⅠB2～ⅡA cervical cancer received sensitivity enhancement of radiotherapy before radical hysterectomy and pelvic lymph node dissection.According to the pathological results,lymph node metastasis sites and metastasis rate were analyzed.Results Eight cases had lymph node metastases(12.5%).Pelvic lymph node metastases had no relationship with patients′age,FIGO stage,the degree of differentiation or pathological types(P 0.05).Among 8 cases,only one group of lymph node metastasis had 6 cases(75.0%),among which 4 cases were obturator lymph nodes(66.7%),1 case was internal iliac lymph node(16.67%),and 1 case was external iliac lymph node(16.7%).Two-group lymph node metastasis had 1 case,which was internal obturator and iliac lymph node;4-group lymph node metastasis at the same time had 1 case,which were obturator-internal iliac/external iliac-inguinal lymph nodes.Conclusion Obturator lymph node was the most common metastasis site in patients with stageⅠB2～ⅡAcervical cancer after sensitivity enhancement of radiotherapy,followed by internal iliac and external iliac lymph node.Pre-operative sensitivity enhancement of radiotherapy for cervical cancer patients may reduce the rate of pelvic lymph node metastasis.
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A radical hysterectomy was performed on patients with stage IA2 to IIB cervical cancer. For these patients, many histopathological parameters have been reported to be prognostic factors of cervical cancer, such as a pelvic lymph node (PLN) metastasis, the histological subtype, the tumor diameter, the depth of the stromal invasion, a lymph-vascular space invasion (LVSI), a parametrial invasion, a corpus invasion and a vaginal invasion. Ovarian cancer is normally treated with cytoreductive surgery followed by chemotherapy. Although physicians have paid a great deal of attention to intraperitoneal disease, a substantial number of ovarian cancers have reported to involve the retroperitoneal lymph nodes. Therefore, a lymph node metastasis has been introduced into FIGO staging. However, the prognostic significance of a lymph node metastasis is controversial. In order to determine the possibility of individualizing a pelvic lymph node (PLN) dissection in patients with endometrial cancer, the relationship between PLN metastasis and the various prognostic factors was investigated. In this paper, various prognostic variables including a lymph node metastasis were analyzed in cervical cancer, endometrial cancer, and ovarian cancer.
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Objective To study the distributional features and high-risk factors of lymph node metastasis of cervical cancer.Methods 71 cases of cervical cancer patients confirmed by biopsy or surgical pathology were selected as the research object,and the logistic multifactor regression analysis was used to analyze the influencing factors of lymph node metastasis.Results Among 71 cervical cancer patients,14 cases had lymph node metastases,the metastasis rate was 19.7%;Single factor analysis showed that tumor diameter,SCCAg level,FIGO stage,pathological type,muscularis infiltrating depth,vascular invasion,differentiation degree were related to lymph node metastasis(P0.05),while there was no correlation among age,surgical cut edge and lymph node metastasis(P0.05);Logistic multifactor regression analysis showed that SCCAg level,vascular invasion,FIGO staging,muscularis infiltrating depth and differentiation degree were 5 independent risk factors of lymph node metastasis before the treatment.Conclusion Before treatment,SCCAg4 ng/ml,the cervical infiltration depth equal or greater than 1/2 of muscular layer,vascular invasion,late FIGO staging and high degree of cell differentiation are the major risk factor of cervical cancer pelvic lymph node metastasis.
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Parametrial
Infiltration (HVAC)
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OBJECTIVE:To study the risk factors for common iliac lymph node metastasis in patients with cervical carcinoma in stage ⅠB-ⅡB and the treatment in patients with positive common iliac lymph node. METHODS: The pathological and clinical features and treatment of cervical carcinoma patients were retrospectively reviewed and analyzed. RESULTS:Of the 652 cases reviewed, 45(6.90%)had positive common iliac lymph node. Single factor analysis showed that clinical stage, number of pelvic lymph node metastasis group (excluding common iliac lymph node), deep cervical stromal invation, lymph-vascular space invasion were associated with common iliac lymph node metastasis. Factors predictive of common iliac lymph node metastasis on logistic forward regression were clinical stage and number of pelvic lymph node metastasis group (excluding common iliac lymph node). CONCLUSIONS: Clinical stage and Number of pelvic lymph node metastasis group (excluding common iliac lymph node) are the independent predictive factors for common iliac lymph metastasis of cervical carcinoma. The treatment of cervical carcinoma patients with positive common iliac lymph node is worth of further study.
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The relationship between clinical and histological factors and prognosis was investigated retrospectively in 60 patients with squamous cell carcinoma of the oral cavity encountered in our clinic during the post 6 years from 1983 to 1988.The subjects were classified into three groups, no metastatic group;metastasis was not recognized within a year after primary treatment, primary metastatic group; metastasis was recognized at first examination, secondary metastatic group;metastasis was recognized after the primary treatment.We performed a comparative study in these three groups especially on the clinical and histological factors.Clinically, we evaluated the tumor size according to the TNM classification of UICC (1987). Histologically, we evaluated the tumor cell population factors (differentiation, nuclear polymorphism and mitosis) according to the classification of WHO and Hanazawa and investigated the histological factors (tumor-host relationship), mode of invasion, stage of invasion and cellular response according to the classification of Yamamoto and Willen.The following results were obtained:1) The relationship between the size of primary lesion and cervical lymph node metastasis was suggested.2) The relationship between the mode of invasion and cervical lymph node metastasis was suggested.3) The relationship between cellular response (cellular reaction against tumor) and cervical lymph node metastasis was suggested.4) The relationship between the stage of invasion and cervical lymph node metastasis was suggested.5) The primary tumor with cervical lymph node metastasis mostly distributed in the cases of M or more for the mode of invasion and T2 or more for the tumor size of primary lesion.6) No distinct relationship was observed between cellular malignancy and cervical lymph node metastasis.7) The primary tumor with cervical lymph node metastasis was mainly distributed in the cases with total histological malignancy score of 9 or more.8) These findings suggest that histological malignancy of the tumor and host cellular reaction against the tumor are more important factors than cellular malignancy of the tumor its, lf when cervical lymph node metastasis is evaluated.
Primary tumor
Cervical lymph nodes
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Objective: To explore the effect of non cancer tissues and organs of the prognosis of gastric cancer lymph node metastasis.Methods: In our hospital in 2003 October-2008 year in January 140 cases of gastric cancer specimens were dissolved fat,get organs lymph node or non lymph node metastatic cancer tissue,and in accordance with its invasion and metastasis type grouping;lymph node metastasis group 56 cases,84 cases without lymph node metastasis group,compared two groups of patients the 5 year survival rate,depth of invasion and differentiation degree,analysis of non lymph node metastasis organ cancer tissue on the prognosis of gastric cancer.Results: The two groups of patients with gastric cancer invasion depth,differentiation degree has no obvious statistical difference;lymph node metastasis in patients with 5 year survival of 27 patients,the survival rate was 48.2%,no lymph node metastasis group patients 5 years survival of 27 cases,the survival rate was 32.1%,two groups of patients 5 years survival rate has no obvious statistical difference.Conclusion: Organ outside the lymph node metastatic cancer tissue has a high invasive depth and differentiation,and lymph node metastases and poor prognosis,similar,therefore,to deal with non lymph node metastasis cancer patients is equivalent to the lymph node metastatic carcinoma treated in the treatment,can not be ignored,to the prognosis of the patients with inference,to improve the quality of life.
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