早期子宫颈鳞癌盆腔淋巴结转移的影响因素

Analysis of the relationship between clinicopathologieal features and pelvic lymph node metastasis in patients with early stage squamons cell carcinoma of the uterine cervix

目的探讨早期（Ⅰb～Ⅱa期）宫颈鳞癌盆腔淋巴结转移的影响因素。方法回顾性分析2004年2月—2007年1月在浙江大学医学院附属妇产科医院接受治疗、资料完整的135例早期宫颈鳞癌患者的临床病理资料。选择10个非重复的特征性因素，包括患者年龄、临床期别、肿瘤直径、病理分化程度、深肌层浸润、脉管浸润、治疗前血清鳞状细胞癌抗原水平，以及治疗前血小板数量、血浆纤维蛋白原和血红蛋白水平，通过单因素和多因素分析研究这些特征性因素与盆腔淋巴结转移之间的关系。结果135例宫颈鳞癌患者中，术后病理检查证实共切除盆腔淋巴结3996枚，平均每例29．6枚（20—47枚）。其中，病理检查证实盆腔淋巴结转移的患者有17例，盆腔淋巴结转移率为12．6％（17／135）。单因素分析结果显示，肿瘤直径（P=0．003）、深肌层浸润（P=0．004）、脉管浸润（P〈0．01）、血小板数量（P=0．006）、血浆纤维蛋白原水平（P〈0．01）是与盆腔淋巴结转移明显相关的因素。多因素分析结果显示，脉管浸润（OR=3．674，95％CI：1．825～7．393，P〈0．01）和血浆纤维蛋白原水平（OR=4．568，95％CI：1．779—11．725，P=0．002）是与盆腔淋巴结转移明显相关的因素。结论脉管浸润和高血浆纤维蛋白原水平是影响早期宫颈鳞癌患者盆腔淋巴结转移的高危因素。

Objective To evaluate clinical and pathologic factors associated with pelvic lymph node metastasis in patients with early-stage squamous cell carcinoma of the uterine cervix. Methods From February 2004 to January 2007, 135 patients with stage Ⅰ b - Ⅱ a cervical squamous cell carcinoma in Women＇s Hospital, School of Medicine, Zhejiang University, were retrospectively studied. The relationship between pelvic lymph node metastasis and age, clinical stage, tumor size, grade of differentiation, depth of muscular invasion, lymphatic vascular space invasion, pretreatment level of serum squamous cell carcinoma antigen, pretreatment plasma level of fihrinogen, pretreatment levels of hemoglobin and platelet were evaluated by univariate and multivariate analyses. Results Totally 3996 lymph nodes were dissected in 135 patients, with an average of 29. 6 lymph nodes in each patient. 12. 6% of the patients （ 17/135 ） had metastasized pelvic lymph nodes. Univariate analysis indicated that tumor size （P = 0. 003 ）, depth of muscular invasion （ P = 0. 004 ）, vascular space invasion （ P 〈 0. 01 ）, pretreatment levels of platelet （ P = 0. 006） and fibrinogen （P 〈 0.01 ） were significantly related to pelvic lymph node metastasis. Multivariate logistic regression analysis showed that lymphatic vascular space invasion （OR： 3.674, 95% CI： 1. 825 - 7. 393, P 〈0. 01 ） and pretreatment plasma level of fibrinogen （ OR： 4. 568, 95% CI： 1. 779 - 11. 725, P = 0. 002） were significantly related to pelvic lymph node metastasis in patients with early-stage squamous cell carcinoma of the uterine cervix. Conclusion In early-stage cervical squamous cell carcinoma, lymphatic vascular space invasion and higher pretreatment plasma levels of fibrinogen are risk factors of pelvic lymph node metastasis.