关键词: 宫颈肿瘤, 淋巴转移, 化学疗法, 辅助

Abstract: Objective：To investigate the characteristics of lymphatic metastasis of locally advanced cervical cancer (LACC) and to evaluate prognostic significance of neoadjuvant chemotherapy (NACT) in patients with LACC (FIGO IB2/IIA2). Methods: Retrospectively analyze the  clinical records and follow-up information of 424 patients with cervical cancer or adenocarcinoma (FIGO IA2-IIA2) after radical hysterectomy in Department of Gynecology, Jiangsu Provincial People′s Hospital From January 2008 to December 2016. Results: In total, 424 patients with cervical cancer were enrolled in the study. Of the 100 patients with LACC, 68 patients underwent direct radical surgery, and 32 patients underwent radical cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. cervical squamous cell carcinoma after 1-2 interventions or neoadjuvant chemotherapy. pelvic lymph node metastasis in 20 cases, and paraaortic lymph node metastasis was not found. Univariate analysis revealed that  deep muscular layer invasion and lymph vascular space invasion (LVSI) was associated with lymph node metastasis (P＜0.05). Histological type, degree of differentiation and whether neoadjuvant chemotherapy were not associated with lymph node metastasis (P＞0.05). Statistically significant single factor Logistic regression analysis showed that LVSI was an independent risk factor for lymph node metastasis (P＜0.05). There was no significant difference of  lymphatic metastasis rate between NACT group and RS group (22.2% vs. 17.2%, P＞0.05). The disease-free survival and overall survival of the LACC group were significantly lower than those of the early cervical cancer group. The NACT group has lower postoperative infection rate, shorter operating duration and less time to keep the abdominal drainage, but there was no statistic significance between the two groups (P＞0.05), and intraoperative ureteral stenting rate, blood transfusion rate and incidence of other adjacent organ injuries were similar in the 2 groups. Conclusions: Locally advanced cervical cancer has poorer prognosis with significantly higher lymphatic metastasis rate than early cervical cancer. Pelvic lymph nodes metastasis was mainly correlated with LVSI and deep muscular layer involvement. Weather neoadjuvant chemotherapy infects the prognosis of advanced cervical cancer is unclear , and there is no evidence that neoadjuvant chemotherapy affects the detection rate of pelvic lymph node metastases. A larger sample or multicenter study is needed in the incidence of surgical-related complications.

Key words: Uterine cervical neoplasms, Lymphatic metastasis, Chemotherapy, adjuvant