ⅠA～ⅡB期宫颈癌盆腔淋巴结转移高危因素的临床分析

Analysis of Risk Factors of ⅠA-ⅡB Cervical Carcinoma with Pelvic Lymph Node Metastasis

目的对宫颈癌淋巴结转移进行分层分析,为评估患者预后和指导个体化的治疗提供依据。方法对286例ⅠA～ⅡB期宫颈癌住院手术患者的临床病理资料进行回顾性分析,对其淋巴结转移的高危因素采用卡方检验和多元logistic回归分析。结果 286例宫颈癌患者盆腔淋巴结转移率为24.1%。影响淋巴结转移的显著的独立危险因素是肿瘤直径(P=0.001),间质浸润(P=0.006);影响淋巴结转移宫颈癌患者预后的独立影响因素是病理类型(P=0.027),宫旁浸润(P=0.067);无宫旁浸润的宫颈鳞癌患者预后最好。结论在ⅠA～ⅡB期宫颈癌中,其前哨淋巴结转移中闭孔淋巴结是最易受累的区域,其次是髂内淋巴结。结合临床病理因素,研究影响宫颈癌患者淋巴结转移的相关高危因素并进行预后评估,可以为其个体化治疗提供依据。

Objective To analyze the risk factors of ⅠA-ⅡB cervical carcinoma with pelvic lymph node metastasis in order to provide the basis for evaluating the prognosis and making an individual therapy for the patients with cervical carcinoma.Methods The clinicopathologic parameters in 286 inpatients with stage ⅠA-ⅡB cervical carcinoma were retrospectively analyzed.The risk factors for pelvic lymph node metastasis were evaluated by the way of univariate χ2 statsistic analysis and binary logistic regression analysis.Results Of the 286 patients with ⅠA-ⅡB cervical carcinoma,the rate of pelvic lymph node metastasis was 24.1%.Tumor diameters（P=0.001）and stromal invasion（P=0.006）were the independent risk factors for pelvic lymph node metastasis;pathological type（P=0.027）and parametrium invasion（P=0.067）were the independent clinicopathological factors influencing prognosis of stage ⅠA-ⅡB cervical carcinoma.Cervical squamous carcinoma without parametrium invasion had best prognosis.Conclusion Pelvic lymph node metastasis always happens in obturator region（21.3%）,followed by internal iliac lymph node.Study on risk factors of cervical carcinoma with pelvic lymph node metastasis and evaluation of the prognosis can provide references for individualized treatment.