伴有腹主动脉旁淋巴结转移的IIIC2期宫颈癌 病例——影像学评估与个体化治疗的挑战与启示

Case of Stage IIIC2 Cervical Cancer with Para-Aortic Lymph Node Metastasis —Challenges and Insights in Imaging Evaluation and Individualized Treatment

摘要: 宫颈癌作为一种常见的恶性肿瘤，其发病率和死亡率在全球范围内持续上升，尤其在中低收入国家尤为显著。本文报告了一例IIIC2期宫颈癌患者的个体化治疗过程，强调了精准分期和个体化治疗在改善患者预后中的重要性。该患者为低分化鳞状细胞癌，侵及深肌层(>2/3肌壁)，存在神经侵犯及脉管内癌栓，Ki-67标记指数高达80%，显示出侵袭性生物学行为。影像学评估在淋巴结转移的判断中存在局限，术前MRI未能准确反映腹主动脉旁淋巴结的情况，导致临床和病理分期不一致。为应对这一挑战，本文探讨了多模态影像学联合评估的重要性，以提高诊断的准确性。同时，强调了同步放化疗和巩固化疗在高风险患者中的应用，指出免疫治疗在晚期宫颈癌中的潜在价值。通过综合考虑患者的生物学特征和整体健康状态，制定个体化治疗策略，有望提升治疗效果和生存率。虽然本研究为个案报道且随访时间有限，但该病例的分析为今后临床实践提供了新的思路和依据，强调了对宫颈癌早期诊断与个体化治疗策略的持续研究的重要性。后续需在更大规模的患者群体中验证结论，以进一步优化IIIC2期宫颈癌的治疗方案。

Abstract: Cervical cancer is a common malignant tumor, with its incidence and mortality rates continuing to rise worldwide, which is particularly significant in low- and middle-income countries. This article reports the individualized treatment process of a patient with stage IIIC2 cervical cancer, emphasizing the importance of accurate staging and individualized treatment in improving the patient’s prognosis. The patient was diagnosed with poorly differentiated squamous cell carcinoma, which invaded the deep myometrium (>2/3 of the myometrial wall). Additionally, the patient had perineural invasion, intravascular tumor thrombus, and a Ki-67 labeling index as high as 80%, all of which indicate aggressive biological behavior of the tumor. Imaging evaluation has limitations in determining lymph node metastasis. Preoperative MRI failed to accurately reflect the status of para-aortic lymph nodes, leading to inconsistencies between clinical and pathological staging. To address this challenge, this article discusses the importance of combined multimodal imaging evaluation to improve the accuracy of diagnosis. Meanwhile, this article emphasizes the application of concurrent chemoradiotherapy and consolidation chemotherapy in high-risk patients, and points out the potential value of immunotherapy in advanced cervical cancer. By comprehensively considering the patient’s biological characteristics and overall health status, formulating an individualized treatment strategy is expected to improve treatment efficacy and survival rate. Although this study is a case report with a limited follow-up period, the analysis of this case provides new ideas and evidence for future clinical practice, and emphasizes the importance of continuous research on early diagnosis and individualized treatment strategies for cervical cancer. In the future, it is necessary to verify the conclusions in a larger-scale patient population to further optimize the treatment regimen for stage IIIC2 cervical cancer.