ERKEN EVRE SERVİKS KANSERİNDE LENF NODU TUTULUMUNU BELİRLEYEN FAKTÖRLER

Öz

Amaç: Lenfatik sistem serviks kanserinde metastatik süreçte önemli rol oynar ve lenf nodu durumu tedaviyi ve prognozu belirler. Bu çal›flmada evre IB1-IIA serviks kanserinde lenf nodu metastaz oran›n› ve bunu belirleyen faktörlerin saptanmas› amaçland›. Materyal ve Metot: 1993-2007 y›llar› aras›nda erken evre serviks kanseri tan›s›yla tip III radikal histerektomi + sistematik pelvik + para-aortik lenfadenktomi yap›lan ve patoloji kayd› yeterli olan 250 hastan›n verileri de¤erlendirildi. Bulgular: Hastalar›n yafl ortalamas› 53.9 y›l ve ortanca tümör boyutu 30 mm’ydi. Hastalar›n 171’i (%68.4) evre IB1, 30’u (%12) evre IB2 ve 49’u (%19.6) evre IIA’yd›. Ç›kar›lan lenf nodu say›s› ortalama 53.4 (13-160) ve metastatik lenf nodu oran› %34’dü. 72 hastada (%28.8) sadece pelvik bölgede, 2 hastada (%0.8) sadece para-aortik bölgede ve 11 hastada (%4.4) her iki bölgede lenf nodu metastaz› saptand›. Metastatik lenf nodu say›s› ortalama 4.1’di (1-39). Parametrium tutulumu, LVSI ve stromal invazyon lenf nodu tutulumunu belirlemekteydi. Yafl›n, evrenin, hücre tipinin, neoadjunat kemoterapinin, vajen ve over metastaz›n›n lenf nodu tutulumuyla iliflkisi yoktu. Sonuçlar: Erken evre serviks kanserinde hastalar›n %34’ünde lenf nodu metastaz› saptand›. Lenf nodu metastaz›n› etkileyen faktörlerin belirlenmesi hastal›¤›n yay›lma paternini anlamam›z› sa¤lamakta ve tedaviyi flekillendirmektedir.

Anahtar Kelimeler

• Serviks kanseri, Lenf nodu metastazı, İzole para-aortik lenf nodu metastazı

Öz

Objective: Lymphatic system has an important role in metastatic process in cervical carcinoma and the lymph node status determinates treatment and survival. In this study, it was aimed to establish the ratio of lymph node metastasis and predicting factors. Materials and Methods: 250 patients with adequate pathologic data who had been operated with type III radical hysterectomy and systematic pelvic + para-aortic lymphadenectomy between 1993 and 2007 were reviewed. Results: The mean age was 53.9 years and tumor size was 30 mm. 171 of patients (68.4%) was in stage IB1, 30 (12%) was in IB2 and 49 (19.6%) was in IIA. The mean number of removed lymph nodes was 53.4 (13-160) and the rate of metastasis to lymph node was 34%. While the only pelvic nodes invasion was discovered in 72 patients (28.8), para-aortic invasion without pelvic metastasis was found in two patients (0.8%) and 11 patients (4.4%) had both of pelvic and para-aortic metastasis. Parametrial invasion, LVSI and stromal invasion predicted metastasis to lymph node. Age, stage, cell type, neoadjuvant chemotherapy, vaginal and ovarian metastasis had no relation to lymph node metastasis. Conclusion: Lymph node metastasis was determinate in 34% of patients. The establishment of factors which is affect to lymph node metastasis elucidate metastatic pattern and it adjust the treatment.

Anahtar Kelimeler

• Cervical carcinoma, Lymph node metastasis, isolated para-aortic lymph node metastasis