宫颈腺癌Ⅰb期患者卵巢转移情况的临床分析

Clinical analysis of ovarian metastasis in patients with I b stage cervical adenocarcinoma

目的通过分析宫颈腺癌的卵巢转移率以及其相关因素，探讨宫颈腺癌卵巢是否保留的问题。方法收集2008年1月至2014年12月分别在中山大学孙逸仙纪念医院和泉州市妇幼保健院住院接受广泛全宫切除术＋盆腔淋巴结切除术的宫颈腺癌患者临床病例资料，共111例，其中孙逸仙纪念医院88例，泉州市妇幼保健院23例，将卵巢转移情况与各临床病理学指标进行统计学分析。结果111例宫颈腺癌患者被纳入研究的患者中位年龄44岁。其中Ⅰb1期65例，Ⅰb2期46例。卵巢转移率为4．5％。单因素分析提示，淋巴脉管浸润（LVSI）、淋巴结状态、间质浸润深度、宫旁组织转移、颈体交界累及情况与卵巢转移相关；多因素分析提示，LVSI（HR：47．01，95％CI：2．48—890．03，P=0．010）及淋巴结状态（HR：23．58，95％CI：1．20—463．21，P=0．038）是宫颈腺癌卵巢转移的独立危险因素。结论宫颈腺癌Ib期卵巢转移率较低，年龄445岁，Ib1期、LSVI阴性、〈1／2宫颈间质浸润、淋巴结阴性、无宫旁转移及无颈体交界累及的患者，可以考虑保留卵巢，结果有待于大样本随机对照试验进一步证实。

Objective To investigate the rate of ovarian metastasis and its related factors in patients with cervical adenocarcinoma, and explore whether the ovary should be reserved or not in cervical adenocarcinoma. Method The clinical data of 111 patients with cervical adenoearcinoma who received extensive total hysterectomy plus pelvic lymph node resection in Sun Yat-sen Memorial Hospital and Quanzhou Women＇s and Children＇s Hospital from Janualy 2008 to December 2014 were collected and analyzed by single factor X^2 test and multivariate logistic regression analysis. Results The median age of the included 111 cases of cervical adenocarcinoma was 44. Sixty-five of the patients were stage Ⅰb1, while 46 were stage Ⅰb2. The single factor analysis indicated that lymph-vascular space invasion （LSVI）, lymph node status, interstitial infiltration depth, parametrial involvement and involvement of cervical body junction were associated with ovarian metastasis. Multivariate analysis indicated that LSVI （HR： 47.01, 95% CI： 2. 48 - 890.03, P = 0. 010） and lymph node status （ FIR. 23.58, 95% CI. 1.20 - 463.21, P = 0. 038 ） were independent risk factors for ovarian metastasis. Conclusions Ovarian metastasis rate of stage ~ b cervical adenocarcinoma is low; patients with age less than or equal to 45 years old, negative LSVI, 〈 1/2 cervical stromal invasion, no lymph node metastasis and no cervical body junction involvement can consider preservation of ovary; but these findings still need to be further confirmed by large randomized controlled trials.