摘要
目的:系统性淋巴结切除术一直是卵巢癌全面分期手术的重要组成部分,但其在术前拟诊为FIGO I期卵巢透明细胞癌(ovarian clear cell carcinoma,OCCC)中的作用存在争议,且过度的淋巴结切除会带来一系列手术并发症风险。因此,本研究旨在探讨临床I期OCCC淋巴结切除数目对患者分期及预后的影响。方法:收集SEER数据库中2010~2017年经手术确诊为pT1N0-1M0期OCCC患者临床及预后资料。使用X-tile软件确定最佳淋巴结切除数目,并将患者分为A、B两组(切除淋巴结≥32枚组和切除淋巴结<32枚组)。淋巴结阳性率等比较采用卡方检验,生存分析采用Kaplan-Meier生存曲线和Log-rank检验。结果:共纳入842例诊断为pT1N0-1M0期的OCCC患者。中位切除淋巴结个数为16个(四分位间距:8,23),其中51例患者(6.1%)淋巴结为阳性。淋巴结阳性的患者中位阳性淋巴结个数为2个(四分位间距:1,3)。A、B两组患者的3年肿瘤特异性生存率分别为91.5%和88.8%,5年肿瘤特异性生存率分别为86.3%和81.8%,差异有统计学意义(χ^(2)=5.902,P=0.021)。此外,A组检出淋巴结阳性的比例略高于B组(分别为6.7%和6.0%),但差异无统计学意义(χ^(2)<0.001,P=0.978)。结论:对于术前诊断为临床I期OCCC患者应至少切除32枚淋巴结以保证准确的手术病理分期及肿瘤学预后。
Objective:Systematic lymphadenectomy has long been an essential component of comprehensive staging sur-gery for ovarian cancer.However,its role in preoperatively diagnosed FIGO stageⅠovarian clear cell carcinoma(OCCC)re-mains controversial,as overly extensive lymph node dissection may lead to various surgical complications.The aim of this study was to explore the effect of lymph node count(LNC)on the staging and prognosis in clinical stageⅠOCCC.Methods:Clinical and prognostic data of patients surgically diagnosed with pT1N0-1M0 OCCC between 2010 and 2017 were collected from the SEER database.The optimal lymph node yield was determined using X-tile software,with patients subsequently stratified into Group A(≥32 lymph nodes removed)and Group B(<32 lymph nodes removed).The comparison of lymph node positivity rates and other parameters was performed using the chi-square test,while survival analysis was conducted with Kaplan-Meier curves and log-rank tests.Results:A total of 842 patients diagnosed with pT1N0-1M0-stage OCCC were in-cluded.The median number of dissected lymph nodes was 16(IQR 8,23),with lymph node metastasis identified in 51 ca-ses(6.1%).The median number of metastatic lymph nodes was 2(IQR 1,3)in node-positive patients.The 3-year canc-er-specific survival rates were 91.5%and 88.8%in groups A and B,respectively,while the 5-year cancer-specific survival rates were 86.3%and 81.8%,with a statistically significant difference(χ^(2)=5.902,P=0.021).Additionally,Group A showed a slightly higher lymph node positivity rate(6.7%)compared to Group B(6.0%),though this difference was not statistically significant(χ^(2)<0.001,P=0.978).Conclusion:Based on our findings,resection of≥32 lymph nodes should be adopted as the standard surgical approach for accurate nodal staging and optimal outcomes in clinical stageⅠOCCC.
作者
刘晓时
王登凤
张国楠
Liu Xiaoshi;Wang Dengfeng;Zhang Guonan(Department of Gynecologic Oncology,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;Department of Oncology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China)
出处
《肿瘤预防与治疗》
2025年第4期306-311,共6页
Journal of Cancer Control And Treatment
基金
四川省肿瘤医院优秀青年基金(编号:YB2024013)。
作者简介
通讯作者:张国楠,E-mail:zhanggn@hotmail.com。
