ⅠA～ⅡB期子宫颈鳞癌盆腔淋巴结转移的临床病理高危因素

Clinicopathological risk factors of pelvic lymph node metastasis of patients withⅠA～ⅡB squamous carcinoma of the cervix

目的探讨影响ⅠA-ⅡB期宫颈鳞癌盆腔淋巴结转移的临床病理高危因素。方法对2004年11月—2013年7月北京大学人民医院接受手术治疗的ⅠA-ⅡB期宫颈鳞癌296例患者的临床病理资料进行回顾性分析,探讨盆腔淋巴结转移的相关高危因素。结果 296例宫颈鳞癌患者中,ⅠA期33例,ⅠB期143例,ⅡA期61例,ⅡB期59例;平均每例切除淋巴结27个,盆腔淋巴结转移率为20.27%（60/296）,其中19例因分别行左、右侧淋巴结整片切除,未能区分淋巴结部位,其余41例淋巴结转移中,闭孔淋巴结最多受累（58.54%,24/41）,其次分别是髂外淋巴结（51.22%,21/41）、髂内淋巴结（31.15%,14/41）、髂总淋巴结（26.83%,11/41）和腹股沟深淋巴结（9.76%,4/41）。单因素分析显示,临床分期、病理分级、肿瘤直径、淋巴脉管间质浸润（LVSI）、宫颈间质浸润深度、子宫浸润及宫旁浸润与宫颈癌盆腔淋巴结转移密切相关（P〈0.05）;多因素分析显示,脉管内癌栓（P=0.000）、宫颈间质浸润深度（P=0.003）及宫旁浸润（P=0.029）是影响ⅠA-ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。结论在ⅠA-ⅡB期宫颈鳞癌中,最易受累的淋巴结是闭孔淋巴结,其次是髂外淋巴结。LVSI、宫旁浸润及宫颈间质浸润深度是ⅠA-ⅡB期宫颈鳞癌盆腔淋巴结转移的显著独立危险因素。

Objective This study aimed to identify the clinicopathological risk factors of pelvic lymph node metastasis of patients with stageⅠA-ⅡB（FIGO stage）squamous carcinoma of the cervix.Methods From November 2004 to July 2013,296 women with stage I A-ⅡB squamous carcinoma of the cervix underwent surgery in Peking Univesity Peoples Hospital.And the data of clinicopathologic parameters were retrospectively collected and analyzed.Moreover,the risk factors for pelvic lymph node metastasis were evaluated.Result There were 33 women with stageⅠA,143 women with stageⅠB,61 patients with stageⅡA and 59 women with stageⅡB.The median number of pelvic lymph nodes removed was 26!11.The rate of pelvic lymph node metastasis was 20.27%（60/296）.Of the 60 cases of pelvic lymph node metastasis,19 cases were failed to distinguish the exact sites of lymph node metastasis due to the whole piece dissection of the right and the left side of pelvic lymph nodes.All of the rest cases,pelvic lymph node metastasis occurred most frequently in obturator region（58.54%,24/41）,followed by external iliac lymph node（51.22%,21/41）,internal iliac lymph nodes（31.15%,14/41）,common iliac lymph nodes（26.83%,11/41）and deep inguinal lymph node（9.76%,4/41）.According to univariateΧ2statsistic analysis,we found that clinical stage,histological grade,tumor diameter,lymph vascular space involvement（LVSI）and depth of stroma invasion,uterine invasion were closely related to pelvic lymph node metastasis.According to binary logistic regression analysis,lymph vascular space involvement（P=0.000）,parametrial extension（P=0.029）and depth of stroma invasion（P=0.030）were the independent clinicopathologic factors.ConclusionPelvic lymph node metastasis occurred most frequently in obturator region,followed by external iliac lymph node.LVSI,parametrial extension and depth of stroma invasion were the independent clinicopathological factors of pelvic lymph node metastasis of patients withⅠA-ⅡB squamous carcinoma of the cervix.