ⅠB~ⅡB期宫颈癌盆腔淋巴结转移相关因素分析

Analysis of factors affecting lymph node metastasis in FIGOⅠB toⅡB uterine cervical cancer

目的:分析IB^IIB期宫颈癌盆腔淋巴结转移情况及相关高危因素,为早期宫颈癌的手术方式提供参考。方法:对158例进行广泛性全子宫切除术联合盆腔淋巴结清扫的IB^IIB期宫颈癌患者的临床病理资料进行回顾性分析,对影响淋巴结转移的因素采用logistic回归分析。结果:158例IB^IIB期宫颈癌有36例淋巴结转移阳性,转移率为22.8%,其中闭孔淋巴结转移22例(占13.9%),髂内淋巴结转移15例(占9.5%),髂外淋巴结转移10例(占6.3%),髂总淋巴结转移7例(占4.4%),腹股沟深淋巴结转移4例(占2.5%),宫旁淋巴结转移1例(占0.6%),腹主动脉旁淋巴结转移1例(占0.6%)。21例孤立淋巴结阳性,15例多组淋巴结阳性。单因素分析结果显示肿瘤直径大小超过4 cm,术前鳞状细胞癌抗原(SCC-Ag)及宫旁浸润与盆腔淋巴结转移相关(P<0.05)。logistic回归分析结果显示肿瘤直径超过4 cm及宫旁浸润是盆腔淋巴结转移的独立危险因素(P<0.05)。结论:IB^IIB期宫颈癌盆腔淋巴结转以闭孔淋巴结最易受累,肿瘤直径超过4 cm及宫旁浸润是盆腔淋巴结转移的高危因素。

Objective：To analysis the factors affecting lymph node metastasis in stage IB1 to IIB uterine cervical cancer. Methods：A total of 158 patients with stage IB to IIB cervical carcinomas treated with radical hysterectomy and systematic pelvic lymphadenectomy were retrospectively analyzed. The logistic multivariate analysis was used to select independent high-risk factors. Results：Thirty-six （22.8%） patients had pelvic lymph node metastasis. Of 36 lymph node metastases, 22 were in the obturator, 15 in the internal iliac, 10 in the external iliac, 7 in the common iliac, 4 in the deep inguinal, 1 in the parametrial iliac and 1 in the para aortic. Univari-ate analysis revealed that tumor size, preoperative SCC-Ag level and parametrial invasion were related to pelvic lymph node metastasis. Multivariate analysis revealed that tumor size greater than 4 cm and parametrial invasion were independently associated with nodal metastasis. Conclusion：The obturator lymph nodes are most frequent-ly involved in stage IB^IIB uterine cervical cancer. Tumor size greater than 4 cm and parametrial invasion are high-risk factors of pelvic lymph node metastasis.