사각근 림프절(scalene lymph node)에 전이된 침윤성 자궁경부암

Abstract

Introduction: The prevalence and mortality of patients with invasive cervical carcinoma have decreased. However, therapeutic results in advanced cervical carcinoma with systemic metastasis was not satisfactory and the therapeutic modalities had lots of morbidities. To know exact extent of disease is important in order to decide pertinent therapeutic modality to each patient. Objectives: We intended to evaluate the risk factors, clinical characteristics, and survival of the cervical cancer patients with scalene lymph node metastasis and, to assess the need of the scalene lymph node biopsy in baseline study of advanced carcinoma of cervix or recurrent carcinoma of cervix. Materials and Methods: We have reviewed clinical charts of total 3624 patients treated for carcinoma of cervix at the department of Obstetrics and Gynecology, Yonsei University College of medicine, from Jan.1981 to Dec.1995. 25 patients (0.68%) were proven to have scalene lymph node metastasis by way of studies including radiologic imaging, physical examination, and lymph node biopsy. Results: Patient' s age ranged from 22 to 80 years with a median of 50 years. The incidence of metastasis was related with the stage at initial diagnosis, pathological type of tumor, existence of para-arotic lymph node metastasis. The patients had other metastasis in 14 cases(66%) and 5 cases had multiple metastatic sites. In spite of aggressive systemic chemotherapy or radiotherapy, the survivial after diagnosis of metastasis was extremely poor, 2- year survival rate was only 9.52%, respectively. Conclusion: The incidence of scalene lymph node metastasis in patients with carcinoma of cervix was very rare in our series, we couldn' t recommend the scalene lymph node biopsy as a modality of baseline study. In patients with paraaortic lymph node metastasis or clinically palpable lymph node, the scalene lymph node biospy may help patients omit aggressive, unnecessary treatment. To prove the value of biopsy of scalene lymph node, well-designed large prospective study would be necessary.