国际生殖健康/计划生育杂志

国际生殖健康/计划生育杂志 ›› 2026, Vol. 45 ›› Issue (3): 184-189.doi: 10.12280/gjszjk.20260042

• 论著 • 上一篇    下一篇

基于SEER数据库分析淋巴结清扫术对FIGOⅡ~Ⅳ期卵巢黏液性癌生存的影响

方瑾, 杨慧, 王志()   

  1. 430014 华中科技大学同济医学院附属武汉中心医院妇产科
  • 收稿日期:2026-01-27 出版日期:2026-05-15 发布日期:2026-06-02
  • 通讯作者: 王志，E-mail：wangzhi2@zxhospital.com

Analysis of the Impact of Lymphadenectomy on Survival in FIGO Ⅱ-Ⅳ Ovarian Mucinous Carcinoma Based on the SEER Database

FANG Jin, YANG Hui, WANG Zhi()   

  1. Department of Obstetrics and Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
  • Received:2026-01-27 Published:2026-05-15 Online:2026-06-02
  • Contact: WANG Zhi, E-mail: wangzhi2@zxhospital.com

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摘要：

目的： 评估淋巴结清扫术在FIGOⅡ~Ⅳ期卵巢黏液性癌患者中应用现状与总生存期的关系，并探讨该关系是否因淋巴结转移状态不同而存在差异。方法： 基于监测、流行病学与结局数据库（Surveillance, Epidemiology, and End Results，SEER），回顾性纳入2004—2021年确诊为FIGO Ⅱ~Ⅳ期原发性卵巢黏液性癌患者，比较接受与未接受淋巴结清扫术患者的临床特征差异，采用Cox比例风险模型评估淋巴结清扫术及其他临床因素与总生存期的关联，并按淋巴结转移状态进行分层分析。结果： 共纳入726例患者，其中340例（46.8%）接受了淋巴结清扫术；有淋巴结病理记录的336例患者中，95例（28.3%）检出淋巴结转移。与未行淋巴结清扫组比较，淋巴结清扫组的患者更年轻、FIGO分期更早、单侧肿瘤比例更高、更可能接受化疗，差异有统计学意义（均P<0.05）。多因素Cox比例风险模型分析显示，淋巴结清扫术与较长的总生存期相关（aHR=0.58，95%CI：0.48~0.70，P<0.001）。按淋巴结转移状态分层分析显示，与未行淋巴结清扫组相比，无淋巴结转移者接受淋巴结清扫术后总生存期更长（HR=0.41，95%CI：0.33~0.50，P<0.001），而伴淋巴结转移者未观察到淋巴结清扫术与总生存期存在显著关联（HR=0.87，95%CI：0.67~1.12，P=0.281）。结论： 淋巴结清扫术在Ⅱ~Ⅳ期卵巢黏液性癌中的临床价值可能主要体现在精准分期和预后分层，直接生存获益有待进一步验证。临床决策应综合考虑患者手术耐受性与淋巴结受累风险进行个体化权衡。

关键词: 卵巢肿瘤, 腺癌, 黏液, 淋巴结切除术, 淋巴转移, 比例危险度模型

Abstract:

Objective: To evaluate the relationship between the application of lymphadenectomy and overall survival in patients with FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma, and to explore whether this relationship differs by lymph node metastasis status. Methods: Based on the Surveillance, Epidemiology, and End Results(SEER) database, we retrospectively identified the patients diagnosed with primary FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma from 2004 to 2021. Clinical characteristics were compared between the patients who underwent lymphadenectomy and those who did not. Cox proportional hazard models were used to assess the association of lymphadenectomy and other clinical factors with overall survival, with stratified analysis conducted according to lymph node metastasis status. Results: A total of 726 patients were included, of whom 340 (46.8%) underwent lymphadenectomy. Among the 336 patients with pathological records of lymph nodes, 95 (28.3%) had lymph node metastasis. Compared with patients of the non-lymphadenectomy group, patients of the lymphadenectomy group were younger, had earlier FIGO stages and higher proportion of unilateral tumors, and were more likely to receive chemotherapy (all P<0.05). Multivariable Cox proportional hazard models analysis showed that lymphadenectomy was independently associated with longer overall survival (aHR=0.58, 95%CI: 0.48-0.70, P<0.001). Stratified analysis by lymph node metastasis status revealed that, compared with the patients of the non-lymphadenectomy group, the patients without lymph node metastasis who underwent lymphadenectomy had significantly longer overall survival (HR=0.41, 95%CI: 0.33-0.50, P<0.001), while no significant association was observed between lymphadenectomy and overall survival in those patients with lymph node metastasis (HR=0.87, 95%CI: 0.67-1.12, P=0.281). Conclusions: The clinical value of lymphadenectomy in FIGO stage Ⅱ-Ⅳ ovarian mucinous carcinoma may primarily lie in accurate staging and prognostic stratification. However, direct survival benefit remains to be further verified. Clinical decision-making should comprehensively balance the surgical tolerance and the risk of nodal metastasis.

Key words: Ovarian neoplasms, Adenocarcinoma, mucinous, Lymph node excision, Lymphatic metastasis, Proportional hazards models