宫颈癌淋巴结转移的危险因素及预后分析

Risk factors and prognosis of node-positive cervical carcinoma

目的：探讨宫颈癌盆腔淋巴结转移的危险因素以及淋巴结转移与患者预后的关系。方法：对328例行广泛性子宫切除及盆腔淋巴结清扫术的宫颈癌患者临床资料进行回顾性分析，应用单因素、多因素分析筛选淋巴结转移的危险因素，Kaplan—Meier法及Log-rank test作生存分析。结果：61例（18．60％）患者259枚淋巴结发生转移，单因素分析表明年龄、临床分期、病理分型、肌层浸润深度、脉管侵犯、分化程度与淋巴结转移相关；多因素分析提示临床分期、肌层浸润深度以及分化程度3个因素是淋巴结转移的独立危险因素。淋巴结转移数为1～2枚组和≥3枚组的5年生存率分别为53．1％和21．4％（P=0．018）；单组淋巴结转移与多组淋巴结转移的5年生存率分别为48．8％和26．8％（P=0．025）。结论：宫颈癌盆腔淋巴结转移的主要危险因素是临床分期、肌层浸润深度以及细胞分化程度．受浸润淋巴结个数和组数越多，患者预后越差。

Objective： To investigate the risk factors and the correlation between lymph nodes metastasis and prognosis. Methods： Clinical datas of 328 cervical cancer patients undergone radical hysterectomy and bilateral pelvic lymphadenectomy were analysed retrospectively. Used univariate analysis and multivariate analysis to screen risk factors, made a survival analysis through Kaplan-Meier analysis and Log-rank test. Results： There were 61 （18.60%） node-positive cases. Univariate analysis showed that risk factors of lymph metastasis were age, clinical stage, pathological type, muscular infiltration, vessel involvement and differentiation grade. Multivariate analysis showed that clinical stage, muscular infiltration and differentiation grade were major risk factors. The 5-year survival rate of the group with 1 to 2 positive nodes and the group with more than 2 positive nodes were 53.1% and 21.4% respectively（P =0. 018）. And the 5-year survival rate of the group with one node-positive site and the group with more than one node-positive site were 48.8% and 26.8% respectively（P = O. 025）. Conclusion： The major risk factors of lymph nodes metastasis in cervical carcinoma are clinical stage, muscular infiltration and differentiation grade; with more positive nodes and more node-positive sites prognosis will be worse.