宫颈鳞癌临床分期和淋巴结转移高危因素分析

Analysis of clinic staging and risk factors of lymph-nodes metastasis in 508 patients with squamous carcinoma of cervix

目的:分析宫颈鳞癌临床分期的准确性、淋巴结转移规律及与各临床病理因素的相关性,探讨淋巴结转移的高危因素及术前临床分期存在的问题和补充改进方法。方法:收集我院行根治性子宫切除+盆腔淋巴结清扫术508例临床ⅠA～ⅡB期宫颈鳞癌患者的临床病理资料,比较临床分期与手术-病理分期(pTNM)的结果,并分析临床病理因素与淋巴结转移之间的关系。结果:临床分期总的准确率为60.2%。单因素分析显示间质浸润深度、淋巴血管间隙浸润(LVSI)、临床分期、宫旁浸润、切缘浸润、阴道浸润、宫体浸润与淋巴结转移相关(P<0.05);多因素分析提示仅间质浸润深度、LVSI、临床分期与淋巴结转移相关(P<0.05)。结论:宫颈鳞癌临床分期的准确性欠佳,应用影像学检查(如MRI)等可能有助于提高分期准确率。间质浸润深度、LVSI、临床分期与淋巴结转移密切相关。

Objective：To analyze the accuracy of clinic staging of squamous carcinoma of cervix, and the relationship between clinico-pathological parameters and lymph-nodes metastasis （LM） ,in order to research the high-risk factors of lymph-nodes metastasis and the existed problems about clinic staging in pre-operation and to analyze how to supplement and improve them. Methods ： The clinico-pathological data of 508 patients who had stage ⅠA～ⅡB of squa- mous carcinoma of cervix and had radical hysterectomy plus pelvic lymphadenectomy were concluded in the study. This clinic staging was compared with operative-pathological staging （ pT- NM classification）, the correlation between clinico-pathological parameters and LM was analyzed. Results： The accuracy of clinic staging was 60.2%. There was correlation among the depth of parametrial invasion, lymph-vascular space invasion （LVSI） , clinic staging, stromal invasion, marginal invasion, vaginal invasion, uterine body invasion and lymph-nodes metastasis in univariable analysis （ P 〈 0.05 ）. While in multivariable analysis, the correlation with LM was only existed among the depth of stromal invasion, LVSI, clinic staging and lymph-nodes metasta- sis. Conehtsiort：The clinic staging of cervical squamous carcinoma in pre-operation is not so satisfying. Application of imaging （ eg. MRI） may be helpful to improve the accuracy of clinic staging. Depth of stromal invasion, LVSI and clinic staging are closely associated with LM.