ⅠB1～ⅡA2期宫颈癌宫旁浸润相关因素分析

Factors associated with parametrial involvement in stage ⅠB1-ⅡA2 cervical cancer

目的分析ⅠB1-ⅡA2期宫颈癌的宫旁转移率及其相关因素,探讨宫颈癌ⅠB1-ⅡA2期宫旁转移的危险因素。方法收集我院1999-2015年经手术治疗的ⅠB1-ⅡA2期宫颈癌患者的临床病理资料,将宫旁浸润与各临床病理指标进行统计学分析。结果宫旁转移率为4.92%。多因素分析提示宫颈浸润深度（OR：3.095,95%CI：1.324-7.235,P=0.009）、淋巴结转移（OR：3.929,95%CI：1.863-8.290,P=0.000）,肿瘤大小（OR：2.446,95%CI：1.167-5.129,P=0.018）是宫旁浸润的独立危险因素。肿块直径≤2 cm且淋巴结无转移的患者宫旁浸润率为0.89%。结论宫颈癌ⅠB1-ⅡA2期宫旁转移率较低,肿块直径≤2 cm,宫颈浸润深度〈1/2并且淋巴结阴性患者可考虑实施损伤较小的手术以减少术后并发症,但仍待大样本随机临床试验进一步证实。

Objective To determine the frequency and risk factors associated with parametrial involvement（PI） in ⅠB1-ⅡA2 cervical cancer patients who underwent radical hysterectomy. Methods Data on 671 cases, who were treated with radical hysterectomy between 1999 and 2015 at Beijing Obstetrics and Gynecology Hospital, were retrospectively reviewed. PI associated factors, including age, clinical stage, tumor size, histological grade, depth of infiltration（DI） and pelvic lymph node involvement（LNI） were compared. Pearson＇s χ2 test and Fisher＇s exact test were used to analyze categorical variables and the risk criteria were analyzed using a logistic regression model. Results Thirty-three patients（4.92%） had PI. In 671 stage ⅠB1-ⅡA2 cases, other than DI（OR：3.095, 95%CI：1.324-7.235, P=0.009） and LNM（OR：3.929, 95%CI：1.863-8.290, P=0.000）, the tumor size（OR：2.446, 95%CI：1.167-5.129, P=0.018） was also an independent risk factor for PI. Among above cases, there were 337 patients with tumor size ≤ 2 cm and no LNI, in which the PI rate was 0.89%（3/337）, which was significantly lower than the tumor size2 cm and（or） LNI patients（P〈0.05）. Conclusion PI rate is low in early stage cervical cancer with the depth of invasion ≤ 1/2 and no LNI, which suggests that the subgroup of patients at low risk of PI can undertake less radical surgery. In this dataset, a model using tumor size and LNI as the PI risk factors can highly predict PI before radical surgery, which could be more feasibile in clinical practice for less radical parametrial resection. However, this should be confirmed by large sample randomized clinical trial.