ⅠB～ⅡA期子宫颈癌患者贫血与盆腔淋巴结转移及预后的关系

Anemia in patients with FIGO Stage ⅠB～ⅡA cervical cancer:association with pelvic lymph node metastases and poor overall survival

目的探讨早期子宫颈癌患者贫血与临床病理因素之间的关系,并分析其对患者生存率的影响。方法回顾性分析454例FIGO分期ⅠB～ⅡA期的子宫颈癌患者临床病理资料,根据术前血红蛋白质量浓度,将患者分为贫血组(HB<110g/L)和非贫血组(HB≥110g/L),比较两组患者临床病理指标之间的差异,并作相关生存分析。结果 99例(21.8%)子宫颈癌患者术前伴有贫血。贫血与FIGO分期晚(P=0.001)、肿瘤大于4cm(P<0.001)、淋巴血管间隙侵犯(LVSI,P=0.028)、宫旁浸润(P=0.030)以及盆腔淋巴结转移(P<0.001)均显著相关,并且是预测盆腔淋巴结转移的独立危险因素之一。贫血组和非贫血组患者的5年总生存率分别为72%和88%(P<0.001)。Cox比例风险回归模型分析显示贫血(P=0.027)、LVSI(P=0.002)和盆腔淋巴结转移(P<0.001)是早期子宫颈癌的独立预后因素。结论贫血与ⅠB～ⅡA期子宫颈癌患者盆腔淋巴结转移相关,且预示患者预后不佳。

Objective To investigate whether there is a correlation between anemia, other clinicopathologic variables, and survival in early cervical cancer patients treated surgically. Methods 454 patients diagnosed with International Federation of Gynecology and Obstetrics （FIGO） stage I B =Ⅱ A cervical carcinoma and treated with surgery were retro- spectivly analysed. Anemia was defined in terms of hemoglobin concentration less than 1 lOg/L. The relationships among pre-treatment anemia presence, clinicopathologic features and prognosis of these patients were evaluated. Results The prevalence of anemia in our patients was 21.8% （ n = 99）. Anemia presence was significantly associated with FIGO stage Ⅱ A（P = 0.001 ）, tumor diameter 〉 4cm （P 〈 0.001 ）, lymph vascular space invasion （ LVSI, P = 0.028 ） , positive parametrium invasion （P = O. 030） and pelvic lymph node metastasis （P 〈 0.001 ）. The multivariate analysis revealed that anemia was one of the independent risk factors for predicting pelvic lymph-node metastasis. The 5-year over- all survival （OS） for anemic and non-anemic patients were 72% and 88% respectively（P 〈 0.001 ）. Using the Cox re- gression analysis, anemia（P = O. 027）,LVSI（P = O. 002）and pelvic lymph nodes metastasis（ P 〈 0. 001 ）were signifi- cant and independent prognostic factors of OS in early cervical cancer patients treated with surgery. Conclusion Pre- treatment anemia is associated with pelvic lymph node metastasis and poor overall survival in patients with early stage cer- vical cancer.