ⅠA2～ⅡA2期宫颈癌主骶韧带浸润情况调查及相关因素分析

The risk factors and invasion rate of cardinal ligament and uterosacral ligament and in Ⅰ A2-Ⅱ A2 cervical cancer

目的调查分析ⅠA2~ⅡA2期宫颈癌主骶韧带浸润情况,探寻影响早期宫颈癌主骶韧带浸润的高危临床病理因素。方法调取5家医院因宫颈癌行手术治疗患者2 982例的临床、病理资料进行回顾性研究。结果 （1）纳入符合研究条件者855例,主骶韧带浸润33例（3.68%）;其中28例（84.85%）为单侧单条韧带浸润,4例（12.12%）2条韧带同时浸润,1例（2.94%）4条韧带浸润;共发生韧带浸润40次,左侧19次（47.5%）,右侧21次（52.5%）,左、右两侧主骶韧带浸润率差异无统计学意义（P=0.749）;（2）随FIGO分期增加,主骶韧带浸润率明显增加（P=0.002）：ⅠA2期无主骶韧带浸润发生,ⅠB1期主骶韧带浸润率2.0%、ⅠB2期2.8%、ⅡA1期9.3%、ⅡA2期6.5%;（3）单因素分析发现患者治疗前鳞状细胞癌抗原水平、宫颈间质浸润深度≥1/2、盆腔淋巴结转移、阴道切缘阳性、阴道穹窿阳性等因素为主骶韧带浸润的危险因素（P〈0.1）;多因素分析确定宫颈间质全层浸润（OR 13.877,95%CI 2.24~82.37）、盆腔淋巴结转移（OR 4.952,95%CI 1.53~16.06）、阴道穹窿阳性（OR 5.658,95%CI 1.48~21.70）为主骶韧带浸润的危险因素（P〈0.05）。结论ⅠA2~ⅡA2期宫颈癌主骶韧带浸润的发生率低,随着FIGO分期的增高,主骶韧带浸润率呈逐渐增高的趋势。宫颈间质全层浸润、盆腔淋巴结转移、阴道穹窿浸润是影响ⅠA2~ⅡA2期宫颈癌主骶韧带浸润的危险因素。

Objective To investigate the invasion rate of cardinal and uterosacral ligaments（ CL/USL） inⅠA2-ⅡA2 stage cervical cancer and to find the related high clinical pathological risk factors. Methods Retrospectively analysed the clinical and pathology data of cervical cancer patients underwent radical hysterectomy from Janurary 2004 to December 2014 at Nanfang Hospital and other four hospitals. Results（ 1） 855 cases of 2982 were selected in the study.The invasion rate of CL / USL was 3. 86%（ 33 /855）. 28 cases（ 84. 85%） were a single ligament infiltration,4 cases（ 12. 12%） were 2 ligaments infiltration,1 case（ 2. 94%） was 4 ligament infiltration. CL and USL ligaments were invased 40 times totally,19（ 47. 5%） on the left and 21（ 52. 5%） on the right side. There was no significant difference between left and right sides（ P = 0. 749）;（ 2） With the increase of FIGO staging,the invasion rate of USL / CL significantly increased（ P = 0. 002） ： None invasion occurred in stage ⅠA2,the invasion rate of ⅠB1 stage was 2. 0%,ⅠB2 stage was 2. 8%,ⅡA1 stage was 9. 3%,ⅡA2 stage was 6. 5%;（ 3） Univariate analysis found that SCCAg level before treatment,cervical stroma infiltration depth greater than or equal to 1 /2,pelvic lymph node metastasis,vaginal cut edge inflitration,vaginal fornix infiltration were risk factors of CL and USL invasion in patients with ⅠA 2- ⅡA2 FIGO stage cervical cancer（ P 0. 1）. Multivariate analysis found that the cervical stroma full- thickness invasion（ OR 13. 877,95%CI 2. 24- 82. 37） and pelvic lymph node metastasis（ OR 4. 952,95% CI 1. 53- 16. 06）,vaginal fornix positive（ OR5. 658,95% CI 1. 48- 21. 70） were risk factors（ P 0. 05）. Conclusion The invasion rate of CL and USL ligaments inⅠA2- ⅡA2 stage cervcial cancer is low and could increase with the increasing of FIGO stage. The cervical stroma full-thickness invasion,pelvic lymph node metastasis and vaginal fornix positive were risk factors of ⅠA2- ⅡA2 stage cervical cancer.