Serviks Kanserinde Lenf Nodu Metastazına Etki Eden Kliniko-Patolojik Faktörler

Abstract

Amaç: Bu çalışmanın amacı, rahim ağzı kanseri hastalarında lenf nodu metastazlarını etkileyen klinikopatolojik faktörleri tanımlamaktır. Materyal ve Metot: Bu retrospektif çalışma Ankara’da Başkent Üniversitesi Jinekolojik Onkoloji Bilim Dalı’nda yapılmıştır. 2008 ile 2019 yılları arasında ameliyat edilen rahim ağzı kanseri hastaları analiz edildi. Hastanın demografik ve patolojik raporları (histoloji, lenfovasküler boşluk invazyonu [LVSI], stromal invazyon, parametrial tutulum, lenf nodu metastazları) belgelendi. Bulgular: Bu çalışmaya toplam 352 rahim ağzı kanseri hastası dahil edildi. Çalışma grubunun ortanca yaşı 49 (23–87) yıl ve ortalama tümör boyutu 3,2 (1–11) cm idi. 273 (%70) hastada pozitif LVSI varken, 299 (%85) hastada servikal stromanın %50’sinden fazla derin stromal invazyon (DSI) vardı. Tek değişkenli analizlerde, DSI, LVSI ve parametrial invazyon lenf nodu metastazlarını etkiledi (sırasıyla p=0,006, p=0,000 ve p=0,000). Ancak, çok değişkenli analizlerde, LVSI (HR: 32,6 (%95 CI: 7,8–136,2, p=0,001) ve parametrial invazyon (HR: 3,52, %95 CI: 1,7–6,9, p=0,001) anlamlı kaldı. Lenf nodu metastazı olan ve olmayan hastaların genel sağkalımı sırasıyla %70 ve %85 idi (p=0,001). Sonuç: LVSI ve parametrial invazyonun, servikal kanser hastalarında lenf nodu metastazı riskini bağımsız olarak artırdığı bulunmuştur. Bu nedenle ameliyat öncesi bu risk faktörlerinin belirlenmesi için ileriye dönük çalışmalara ihtiyaç vardır.

Keywords

• rahim ağzı kanseri
• lenf nodu metastazları
• sağ kalma

Clinico-Pathologic Factors Affecting Lymph Node Metastases in Cervical Cancer

Abstract

Aim: The aim of this study was to define clinico-pathologic factors affecting lymph node metastases in cervical cancer patients. Material and Method: This retrospective study was carried out in the Gynecologic Oncology Division of Baskent University in Ankara, Turkey. Cervical cancer patients operated on between 2008 and 2019 were analyzed. Patient’s demographic and pathologic reports (histology, lymphovascular space invasion [LVSI], stromal invasion, parametrial involvement, lymph node metastases) were documented. Results: A total of 352 cervical cancer patients were included in this study. The median age of the study group was 49 (23–87) years and the median tumor size was 3.2 (1–11) cm. While 273 (70%) patients had positive LVSI, 299 (85%) patients had deep stromal invasion (DSI) of more than 50% of the cervical stroma. In univariant analyses, DSI, LVSI, and parametrial invasion affected lymph node metastases (p=0.006, p=0.000, and p=0.000, respectively). However, in multivariant analyses, LVSI (HR: 32.6 (95% CI: 7.8–136.2, p=0.001) and parametrial invasion (HR: 3.52, 95% CI: 1.7–6.9, p=0.001) remained significant. Five-year overall survival of patients with and without lymph node metastases was 70% and 85%, respectively (p=0.001). Conclusion: LVSI and parametrial invasion were found to independently increase the risk of lymph node metastases in cervical cancer patients. For this reason, prospective studies are needed to identify these risk factors preoperatively.

Keywords

• cervical cancer
• lymph node metastases
• survival

References

1. 1. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020;8: e191-e203.
2. 2. Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Chan J, et al. Cervical cancer. J Natl Compr Canc Netw 2013;11:320–43.
3. 3. Bhatla N, Berek JS, Cuello Fredes M, Denny LA, Grenman S, Karunaratne K, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019;145:129–35.
4. 4. Matsuo K, Machida H, Mandelbaum RS, Konishi I, Mikami M. Validation of the 2018 FIGO cervical cancer staging system. Gynecol Oncol 2019;152:87–93.
5. 5. Ayhan A, Aslan K, Bulut AN, Akilli H, Öz M, Haberal A, Meydanli MM. Is the revised 2018 FIGO staging system for cervical cancer more prognostic than the 2009 FIGO staging system for women previously staged as IB disease? Eur J Obstet Gynecol Reprod Biol 2019;240:209–14.
6. 6. Wang R, Tao X, Wu X, Jiang H, Xia H. Number of Removed Pelvic Lymph Nodes as a Prognostic Marker in FIGO Stage IB1 Cervical Cancer with Negative Lymph Nodes. J Minim Invasive Gynecol 2020;27:946–52.
7. 7. Baalbergen A, Ewing-Graham PC, Hop WC, Struijk P, Helmerhorst TJ. Prognostic factors in adenocarcinoma of the uterine cervix. Gynecologic oncology 2004;92:262–7.
8. 8. Morice P, Piovesan P, Rey A, Atallah D, Haie-Meder C, Pautier P, et al. Prognostic value of lymphovascular space invasion determined with hematoxylin-eosin staining in early stage cervical carcinoma: results of a multivariate analysis. Ann Oncol 2003;14:1511–7.

9. 9. Milam MR, Frumovitz M, dos Reis R, Broaddus RR, Bassett RL, Jr., Ramirez PT. Preoperative lymph-vascular space invasion is associated with nodal metastases in women with early-stage cervical cancer. Gynecologic oncology 2007;106:12–5.
10. 10. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999;73:177–83.
11. 11. Chernofsky MR, Felix JC, Muderspach LI, Morrow CP, Ye W, Groshen SG, Roman LD. Influence of quantity of lymph vascular space invasion on time to recurrence in women with early-stage squamous cancer of the cervix. Gynecologic oncology 2006;100:288–93.
12. 12. Singh P, Tripcony L, Nicklin J. Analysis of prognostic variables, development of predictive models, and stratification of risk groups in surgically treated FIGO early-stage (IA-IIA) carcinoma cervix. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society 2012;22:115–22.
13. 13. Yan M, Zhang YN, He JH, Sun JR, Sun XM. Influence of lymph vascular space invasion on prognosis of patients with early-stage cervical squamous cell carcinoma. Chin J Cancer 2010;29:425–30.
14. 14. Creasman WT, Kohler MF. Is lymph vascular space involvement an independent prognostic factor in early cervical cancer? Gynecologic oncology 2004;92:525–9.
15. 15. Akilli H, Tohma YA, Bulut AN, Karakas LA, Haberal AN, Kuscu UE, Ayhan A. Comparison of no adjuvant treatment and radiotherapy in early-stage cervical carcinoma with intermediate risk factors. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2020;149:298–302.
16. 16. Liu Y, Zhao LJ, Li MZ, Li MX, Wang JL, Wei LH. The Number of Positive Pelvic Lymph Nodes and Multiple Groups of Pelvic Lymph Node Metastasis Influence Prognosis in Stage IA-IIB Cervical Squamous Cell Carcinoma. Chin Med J (Engl)2015;128:2084–9.
17. 17. Nanthamongkolkul K, Hanprasertpong J. Predictive Factors of Pelvic Lymph Node Metastasis in Early-Stage Cervical Cancer. Oncol Res Treat 2018;41:194–8.
18. 18. Xia X, Xu H, Wang Z, Liu R, Hu T, Li S. Analysis of Prognostic Factors Affecting the Outcome of Stage IB-IIB Cervical Cancer Treated by Radical Hysterectomy and Pelvic Lymphadenectomy. American Journal of Clinical Oncology 2016;39:604–8.
19. 19. Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, et al. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstetricia et Gynecologica Scandinavica 2002;81:1144–51.
20. 20. Marth C, Landoni F, Mahner S, McCormack M, GonzalezMartin A, , et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017;28: iv72-iv83. Erratum in: Ann Oncol 2018;29(Suppl 4): iv262. Erratum in: Ann Oncol 2018;29(Suppl 4): iv262.
21. 21. Kasamatsu T, Onda T, Sawada M, Kato T, Ikeda S. Radical hysterectomy for FIGO stage IIB cervical cancer: clinicopathological characteristics and prognostic evaluation. Gynecologic Oncology 2009;114:69–74.
22. 22. Suprasert P, Srisomboon J, Charoenkwan K, Siriaungul S, Khunamornpong S, Siriaree S, et al. Outcomes of abandoned radical hysterectomy in patients with stages IB-IIA cervical cancer found to have positive nodes during the operation. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society 2005;15:498– 502.
23. 23. Yuan L, Guo J, Zhang X, Chen M, Xu C, Yao L. Feasibility of radical hysterectomy in women with FIGO stage IIB cervical cancer: an observation study of 10-year experience in a tertiary center. Onco Targets Ther 2018;11:5527–33.
24. 24. Cibula D, McCluggage WG. Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions. Gynecol Oncol 2019;152:202–7.