Serviks Kanserinde Lenf Nodu Metastazına Etki Eden Kliniko-Patolojik Faktörler

Öz

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.

Anahtar Kelimeler

• rahim ağzı kanseri
• lenf nodu metastazları
• sağ kalma

Clinico-Pathologic Factors Affecting Lymph Node Metastases in Cervical Cancer

Öz

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.

Anahtar Kelimeler

• cervical cancer
• lymph node metastases
• survival

Kaynakça

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