Araştırma Makalesi
Effect of high rist factors including lymph node metastasis, parametrial invasion, positive surgical margin on prognosis of patients treated with type III radical hysterectomy for cervical cancer stage Ib
Öz
Aim. In this study we analyze the effect of risk factors (lymph node metastasis, parametrial invasion, positive surgical margin) determining high risk group on prognosis after radical hysterectomy. Method. Files of the patients with cervical cancer stage IB those were treated with type III radical hysterectomy +/- bilateral salpingoopherectomy+ systemic bilateral pelvicparaaortic lymphadenectomy in our clinics between 1993-2007 investigated retrospectively. We included 119 patients who were not treated with neoadjuvant chemotherapy, who had sufficent data of pathology, who had at least 5 year follow up or who had recurrent disease or die in five years. Results. Median age of the patients was 53,8 (34-80) and mean tumor size was 30 mm (5- 65). According to the postoperative pathology reports, 54 patients (45,4%) had one or more parameters of high risk group. There were 40 patients with one, 10 patients with two, 4 patients with three risk factors. In whole group 5 year disease free life was 78.2%, survival rate was 80.7%. There was a significant negative effect of presence of risk factors on survival rates. In patients with no high risk factor, 5 year disease free life rate was 87.7% and 5 year survival rate was 90.8%. In the presence of one or more of these factors these ratios decrease to 66.7% and 68.5% reciprocally. Number of positive risk factors of patients was not significant. Conclusion. In this study it is shown that current high risk definition is valid and usefull.
Anahtar Kelimeler
Kaynakça
- Creasman WT. New gynecologic cancer staging. Gynecol Oncol 1995; 58: 157-8
- Kodaira T, Fuwa N, Toita T, Nomoto Y, Kuzuya K, Tachibana H, Furutani K, Ogawa K. Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56: 769-77.
- Narayan K, McKenzie AF, Hicks RJ, Fisher R, Bernshaw D, Bau S. Relation between FIGO stage, primary tumor volume, and presence of lymph node metastases in cervical cancer patients referred for radiotherapy. Int J Gynecol Cancer 2003; 13: 657-63.
- Morrow CP. Panel report: is pelvic radiation beneficial in the postoperative management of Stage IB squameus cell carcinoma of the cervix with pelvic lymph node metastases treated by radical hysterectomy and pelvic lymphadenectomy Gynecol Oncol 1980; 10:105.
- Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical- pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990; 38: 352-7.
- Lai CH, Chang HC, Chang TC, Hsueh S, Tang SG. Prognostic factors and impacts of adjuvant therapy in early-stage cervical carcinoma with pelvic node metastases. Gynecol Oncol 1993;51: 390-6.
- Atkovar G, Uzel O, Ozsahin M, Koca S, Sahinler I, Okkan S, Uzel R. Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors. Radiother Oncol 1995; 35: 198-205.
- Lin HH, Cheng WF, Chan KW, Chang DY, Chen CK, Huang SC. Risk factors for recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Obstet Gynecol 1996; 88: 274-9.
- Schorge JO, Molpus KL, Koelliker D, Nikrui N, Goodman A, Fuller AF, Jr. Stage IB and IIA cervical cancer with negative lymph nodes: the role of adjuvant radiotherapy after radical hysterectomy. Gynecol Oncol 1997; 66: 31-5.
- Hart K, Han I, Deppe G, Malviya V, Malone J, Jr., Christensen C, Chuba P, Porter A. Postoperative radiation for cervical cancer with pathologic risk factors. Int J Radiat Oncol Biol Phys 1997; 37: 833-8.
- Tsai CS, Lai CH, Wang CC, Chang JT, Chang TC, Tseng CJ, Hong JH. The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy. Gynecol Oncol 1999; 75: 328-33.
- Kim SM, Choi HS, Byun JS. Overall 5-year survival rate and prognostic factors in patients with stage IB and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection. Int J Gynecol Cancer 2000; 10: 305-12.
- Okada M, Kigawa J, Minagawa Y, Kanamori Y, Shimada M, Takahashi M Oishi T, Terakawa N. Indication and efficacy of radiation therapy following radical surgery in patients with stage IB to IIB cervical cancer. Gynecol Oncol 1998; 70: 61-4.
- Sedlis A, Bundy BN, Rotman M, Lentz SS, Muderspach LI, Ziano R. A randomized Trial of pelvic Radiation Therapy versus No Futher 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.
- Soisson AP, Soper JT, Clarke-Pearson DL, Berchuck A, Montana G, Creasman WT: Adjuvant radiotherapy following radical hysterectomy for patients with stage 1B, and IIA cervical cancer. Gynecol Oncol 1990; 37: 390-95.
- Piver MS, Chung WS. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol 1975; 46: 507-42.
- Shimada M, Kigawa J, Takahashi M, Minagawa Y, Okada M, Kanamori Y, Itamochi H, Oishi T, Iba T, Terakawa N. Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer. Gynecol Oncol 2004; 93: 628-31.
- Pieterse QD, Trimbos JB, Dijkman A, Creutzberg CL, Gaarenstroom KN, Peters AA, Kenter GG. Postoperative radiation therapy improves prognosis in patients with adverse risk factors in localized, early stage cervical cancer; a retrospective comparative study: Int J Gynecol Cancer 2006; 16: 1112-8.
- Yasuda S, Kojıma A, Maeno Y, Okı N, Mıyahara Y, Sudo T, Takekıda S, Yamaguchı S, Nıshımura R. Poor Prognosis of patients with Stage IB1 Adenosquamous Cell Carcinoma of the Uterine Cervix with Pelvic Lyphnode Metastasis. Kobe J. Med. Sci 2006; 52: 9-15
- Lee JM, Lee KB, Lee SK, Park CY. Pattern of lymph node metastasis and the optimal extent of pelvic lymphadenectomy in FIGO stage IB cervical cancer. J Obstet Gynaecol Res 2007; 33: 288-93.
- Sironi S, Buda A, Picchio M, Perego P, Moreni R, Pellegrino A, Colombo M, Mangioni C, Messa C, Fazio F. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology 2006 Jan;238: 272-9.
- Sakuragi N, Satoh C, Takeda N, Hareyama H, Takeda M, Yamamoto R, Fujimoto T, Oikawa M, Fujino T, Fujimoto S. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 1999; 85: 1547-54
- Novaković P, Mandić A, Vujkov T, Tesi M, Rajović J, Zivaljević M, Popović M. Radical hysterectomy for stage IB1 cervical carcinoma: lymph node metastasis as a prognostic factor. J BUON 2002; 7: 247-50
- Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 2002; 81: 1144-51
- Monk BJ, Cha DS, Walker JL, Burger RA, Ramsinghani NS, Manetta A, DiSaia PJ, Berman ML. Extent of disease as an indication for pelvic radiation following radical hysterectomy and bilateral pelvic lymph node dissection in the treatment of stage IB and IIA cervical carcinoma. Gynecol Oncol 1994; 54: 4-9.
- Xiong Y, Liang L, Peng X, Wei M, Shen Y. Prognostic factors for patients with FIGO Stage-IB cervical squamous cell carcinoma: Does the tumor size (≤ 4 cm or > 4 cm) really matter? Chinese Journal Of Clinical Oncology 2007 ; 4: 115-20.
- Metindir J, Bilir G. Prognostic factors affecting disease-free survival in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic-paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2007; 28: 28-32
- Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli OR, Averette HE. Prognostic factors of early stage cervical cancer treated by radical hysterectomy. Cancer 1995; 76(10 Suppl):1978-86
- Kamura T, Shigematsu T, Kaku T, Shimamoto T, Saito T, Sakai K, Mitsumoto M, Nakano H. Histopathological factors influencing pelvic lymph node metastases in two or more sites in patients with cervical carcinoma undergoing radical hysterectomy. Acta Obstet Gynecol Scand 1999;78: 452-7
- Henriksen E . The lymphatic spread of carcinoma of the cervix and of the body of the uterus; a study of 420 necropsies. Am J Obstet Gynecol 1949; 58: 924-42
- Wright JD, Grigsby PW, Brooks R, Powell MA, Gibb RK, Gao F, Rader JS, Mutch DG. Utility of Parametrectomy for Early stage Cervical Cancer Treated With Radical Hysterectomy. Cancer 2007 Sep 15;110: 1281-6.
- Liu MT, Hsu JC, Liu WS, Wang AY, Huang WT, Chang TH, Pi CP, Huang CY, Huang CC, Chou PH, Chen TH. Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy. Eur J Cancer Care (Engl). 2008;17: 174-81.
- Chun HC, Lee MZ. Role of Postoperative Radiation Therapy in the Management J Korean Soc Ther Radiol Oncol 2004 ;22: 265-70.
- Estape RE, Angioli R, Madrigal M, Janicek M, Gomez C, Penalver M, Averette H. Close vaginal margines as a prognostic factor after radical hysterectomy Gynecol Oncol1998;68: 229
Tip III radikal histerektomiyle tedavi edilmiş serviks Ib karsinomunda parametriyal invazyon, lenf nodu metastazı ve cerrahi sınır pozitifliği gibi yüksek risk faktörlerinin prognostik önemi
Öz
Bu çalışmada radikal histerektomi sonrası yüksek-risk grubunu belirleyen faktörlerin (lenf nodu metastazı, parametriyal invazyon, cerrahi sınır pozitifliği) prognoz üzerindeki etkisi değerlendirildi. Yöntem. Kliniğimizde 1993-2007 yılları arasında evre IB serviks kanseri tanısı alıp tip III radikal histerektomi +/- bilateral salpingo-ooforektomi + sistematik bilateral pelvik-paraaortik lenfadenektomi yapılan hastaların dosyaları tarandı. Neoadjuvant kemoterapi almayan, patoloji kaydı yeterli olan ve en az 5 yıllık takibi olan veya 5 yıl içinde nüks gelişen veya ölen 119 hastanın verileri gözden geçirildi. Bulgular. Hastaların ortalama yaşı 53,8 (34-80) ve ortanca tümör boyutu 30 mm idi (5-65). Operasyon sonrası patoloji sonucuna göre yüksek risk grubundan herhangi bir parametreyi taşıyan hastaların sayısı 54'tü (%45,4). Bunlardan 40 olgunun sadece bir, 10 olgunun iki ve dört olgunun üç yüksek risk faktörü taşıdığı belirlendi. Tüm grupta 5 yıllık hastalıksız yaşam oranı %78,2, sağ kalım oranı %80,7 idi. Risk faktörlerinin varlığı yaşam oranlarını belirgin olarak kötüleştirmekteydi. Bu faktörlerden hiç birinin olmadığı hastalarda 5 yıllık hastalıksız yaşam oranı %87,7, 5 yıllık sağ kalım oranı %90,8'di. Ancak risk faktörlerinden her hangi birinin varlığı durumunda bu oranlar sırasıyla %66,7'ye ve %68,5'e düşmekteydi. Hastadaki pozitif risk faktörü sayısının önemli olmadığı görüldü. Sonuç. Bu çalışmada, günümüzde kabul edilen yüksek-risk tanımlamasının doğru bir tanımlama olduğu görüldü.
Anahtar Kelimeler
Kaynakça
- Creasman WT. New gynecologic cancer staging. Gynecol Oncol 1995; 58: 157-8
- Kodaira T, Fuwa N, Toita T, Nomoto Y, Kuzuya K, Tachibana H, Furutani K, Ogawa K. Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56: 769-77.
- Narayan K, McKenzie AF, Hicks RJ, Fisher R, Bernshaw D, Bau S. Relation between FIGO stage, primary tumor volume, and presence of lymph node metastases in cervical cancer patients referred for radiotherapy. Int J Gynecol Cancer 2003; 13: 657-63.
- Morrow CP. Panel report: is pelvic radiation beneficial in the postoperative management of Stage IB squameus cell carcinoma of the cervix with pelvic lymph node metastases treated by radical hysterectomy and pelvic lymphadenectomy Gynecol Oncol 1980; 10:105.
- Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical- pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990; 38: 352-7.
- Lai CH, Chang HC, Chang TC, Hsueh S, Tang SG. Prognostic factors and impacts of adjuvant therapy in early-stage cervical carcinoma with pelvic node metastases. Gynecol Oncol 1993;51: 390-6.
- Atkovar G, Uzel O, Ozsahin M, Koca S, Sahinler I, Okkan S, Uzel R. Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors. Radiother Oncol 1995; 35: 198-205.
- Lin HH, Cheng WF, Chan KW, Chang DY, Chen CK, Huang SC. Risk factors for recurrence in patients with stage IB, IIA, and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation. Obstet Gynecol 1996; 88: 274-9.
- Schorge JO, Molpus KL, Koelliker D, Nikrui N, Goodman A, Fuller AF, Jr. Stage IB and IIA cervical cancer with negative lymph nodes: the role of adjuvant radiotherapy after radical hysterectomy. Gynecol Oncol 1997; 66: 31-5.
- Hart K, Han I, Deppe G, Malviya V, Malone J, Jr., Christensen C, Chuba P, Porter A. Postoperative radiation for cervical cancer with pathologic risk factors. Int J Radiat Oncol Biol Phys 1997; 37: 833-8.
- Tsai CS, Lai CH, Wang CC, Chang JT, Chang TC, Tseng CJ, Hong JH. The prognostic factors for patients with early cervical cancer treated by radical hysterectomy and postoperative radiotherapy. Gynecol Oncol 1999; 75: 328-33.
- Kim SM, Choi HS, Byun JS. Overall 5-year survival rate and prognostic factors in patients with stage IB and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection. Int J Gynecol Cancer 2000; 10: 305-12.
- Okada M, Kigawa J, Minagawa Y, Kanamori Y, Shimada M, Takahashi M Oishi T, Terakawa N. Indication and efficacy of radiation therapy following radical surgery in patients with stage IB to IIB cervical cancer. Gynecol Oncol 1998; 70: 61-4.
- Sedlis A, Bundy BN, Rotman M, Lentz SS, Muderspach LI, Ziano R. A randomized Trial of pelvic Radiation Therapy versus No Futher 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.
- Soisson AP, Soper JT, Clarke-Pearson DL, Berchuck A, Montana G, Creasman WT: Adjuvant radiotherapy following radical hysterectomy for patients with stage 1B, and IIA cervical cancer. Gynecol Oncol 1990; 37: 390-95.
- Piver MS, Chung WS. Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol 1975; 46: 507-42.
- Shimada M, Kigawa J, Takahashi M, Minagawa Y, Okada M, Kanamori Y, Itamochi H, Oishi T, Iba T, Terakawa N. Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer. Gynecol Oncol 2004; 93: 628-31.
- Pieterse QD, Trimbos JB, Dijkman A, Creutzberg CL, Gaarenstroom KN, Peters AA, Kenter GG. Postoperative radiation therapy improves prognosis in patients with adverse risk factors in localized, early stage cervical cancer; a retrospective comparative study: Int J Gynecol Cancer 2006; 16: 1112-8.
- Yasuda S, Kojıma A, Maeno Y, Okı N, Mıyahara Y, Sudo T, Takekıda S, Yamaguchı S, Nıshımura R. Poor Prognosis of patients with Stage IB1 Adenosquamous Cell Carcinoma of the Uterine Cervix with Pelvic Lyphnode Metastasis. Kobe J. Med. Sci 2006; 52: 9-15
- Lee JM, Lee KB, Lee SK, Park CY. Pattern of lymph node metastasis and the optimal extent of pelvic lymphadenectomy in FIGO stage IB cervical cancer. J Obstet Gynaecol Res 2007; 33: 288-93.
- Sironi S, Buda A, Picchio M, Perego P, Moreni R, Pellegrino A, Colombo M, Mangioni C, Messa C, Fazio F. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology 2006 Jan;238: 272-9.
- Sakuragi N, Satoh C, Takeda N, Hareyama H, Takeda M, Yamamoto R, Fujimoto T, Oikawa M, Fujino T, Fujimoto S. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer 1999; 85: 1547-54
- Novaković P, Mandić A, Vujkov T, Tesi M, Rajović J, Zivaljević M, Popović M. Radical hysterectomy for stage IB1 cervical carcinoma: lymph node metastasis as a prognostic factor. J BUON 2002; 7: 247-50
- Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S. Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Acta Obstet Gynecol Scand 2002; 81: 1144-51
- Monk BJ, Cha DS, Walker JL, Burger RA, Ramsinghani NS, Manetta A, DiSaia PJ, Berman ML. Extent of disease as an indication for pelvic radiation following radical hysterectomy and bilateral pelvic lymph node dissection in the treatment of stage IB and IIA cervical carcinoma. Gynecol Oncol 1994; 54: 4-9.
- Xiong Y, Liang L, Peng X, Wei M, Shen Y. Prognostic factors for patients with FIGO Stage-IB cervical squamous cell carcinoma: Does the tumor size (≤ 4 cm or > 4 cm) really matter? Chinese Journal Of Clinical Oncology 2007 ; 4: 115-20.
- Metindir J, Bilir G. Prognostic factors affecting disease-free survival in early-stage cervical cancer patients undergoing radical hysterectomy and pelvic-paraaortic lymphadenectomy. Eur J Gynaecol Oncol 2007; 28: 28-32
- Sevin BU, Nadji M, Lampe B, Lu Y, Hilsenbeck S, Koechli OR, Averette HE. Prognostic factors of early stage cervical cancer treated by radical hysterectomy. Cancer 1995; 76(10 Suppl):1978-86
- Kamura T, Shigematsu T, Kaku T, Shimamoto T, Saito T, Sakai K, Mitsumoto M, Nakano H. Histopathological factors influencing pelvic lymph node metastases in two or more sites in patients with cervical carcinoma undergoing radical hysterectomy. Acta Obstet Gynecol Scand 1999;78: 452-7
- Henriksen E . The lymphatic spread of carcinoma of the cervix and of the body of the uterus; a study of 420 necropsies. Am J Obstet Gynecol 1949; 58: 924-42
- Wright JD, Grigsby PW, Brooks R, Powell MA, Gibb RK, Gao F, Rader JS, Mutch DG. Utility of Parametrectomy for Early stage Cervical Cancer Treated With Radical Hysterectomy. Cancer 2007 Sep 15;110: 1281-6.
- Liu MT, Hsu JC, Liu WS, Wang AY, Huang WT, Chang TH, Pi CP, Huang CY, Huang CC, Chou PH, Chen TH. Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy. Eur J Cancer Care (Engl). 2008;17: 174-81.
- Chun HC, Lee MZ. Role of Postoperative Radiation Therapy in the Management J Korean Soc Ther Radiol Oncol 2004 ;22: 265-70.
- Estape RE, Angioli R, Madrigal M, Janicek M, Gomez C, Penalver M, Averette H. Close vaginal margines as a prognostic factor after radical hysterectomy Gynecol Oncol1998;68: 229
Toplam 34 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 25 Haziran 2009 |
| Yayımlandığı Sayı | Yıl 2009Cilt: 31 Sayı: 3 |