根治性宫颈癌手术患者盆腔淋巴结转移和预后的影响因素分析

Factors affecting pelvic lymph node metastasis and prognosis of patients undergoing radical surgery for cervical cancer

目的探讨根治性宫颈癌手术患者盆腔淋巴结转移和5年生存率的影响因素。方法选择2007年1月—2012年12月嘉兴市妇幼保健院宫颈癌Ⅰa~Ⅱb期手术患者225例作为研究对象,收集患者的临床病理资料。结果 225例宫颈癌患者中淋巴结转移者54例,转移率为24.0%。治疗前血红蛋白水平<110 g/L、FIGO分期Ⅱ期、肌层浸润深度≥1/2、有宫旁浸润、有淋巴血管间隙侵犯、肿瘤直径≥4 cm的淋巴结转移率高于治疗前血红蛋白水平≥110 g/L、FIGO分期Ⅰ期、肌层浸润深度<1/2、无宫旁浸润、无淋巴血管间隙侵犯、肿瘤直径<4 cm者(P<0.05)。治疗前血红蛋白水平、FIGO分期、宫旁浸润、淋巴血管间隙侵犯、肿瘤直径为宫颈癌淋巴结转移的独立影响因素(P<0.05)。宫颈癌患者的5年生存率为83.7%。年龄≥45岁、治疗前血红蛋白水平<110 g/L、FIGO分期Ⅱ期、肌层浸润深度≥1/2、有宫旁浸润、有淋巴血管间隙侵犯、肿瘤直径≥4 cm、非鳞癌、有淋巴结转移患者的5年生存率低于年龄<45岁、治疗前血红蛋白水平≥110 g/L、FIGO分期Ⅰ期、肌层浸润深度<1/2、无宫旁浸润、无淋巴血管间隙侵犯、肿瘤直径<4 cm、鳞癌、无淋巴结转移患者的5年生存率(P<0.05)。治疗前血红蛋白水平、淋巴血管间隙侵犯、非鳞癌和淋巴结转移是宫颈癌患者5年生存率的独立影响因素(P<0.05)。结论治疗前血红蛋白水平、FIGO分期、宫旁浸润、淋巴血管间隙侵犯、肿瘤直径为宫颈癌淋巴结转移的独立影响因素。治疗前血红蛋白水平、淋巴血管间隙侵犯、非鳞癌和淋巴结转移是宫颈癌患者预后的独立影响因素。

Objective To explore the factors affecting pelvic lymph node metastasis and 5-year survival rate of patients undergoing radical surgery for cervical cancer. Methods The clinical and pathological data of 225 cases of stage 1A- 2B cervical cancer undergoing radical surgery in our hospital between January,2007 and December,2012 were reviewed and analyzed respectively. Results Among 225 cases of cervical cancer,there were 54 cases of lymph node metastasis with a rate of 24. 0%. The patients with hemoglobin level〈 110 g / L before the treatment,FIGO stage Ⅱ,depth of myometrial invasion≥1 /2,parametrial invasion,lymph-vascular space invasion,tumor diameter≥4 cm usually had high metastasis rate of lymph node when compare with the patients with the hemoglobin level≥110 g / L before the treatment,FIGO stage Ⅰ,myometrial invasion 〈1 /2,no parametrial invasion,without lymph-vascular space invasion,tumor diameter 〈4 cm patients（ P 〈0. 05）. Hemoglobin level before the treatment,FIGO stage,parametrial invasion,lymph-vascular space invasion and tumor diameter were the independent factors of cervical lymph node metastasis（ P 〈0. 05）. The 5-year survival rate of cancer patients was 83. 7%. The 5-year survival of patients with age ≥45 years,hemoglobin level 〈110 g / L before treatment,FIGO stage Ⅱ,depth of myometrial invasion≥1 /2,parametrial invasion,lymph-vascular space invasion,tumor diameter ≥4 cm,non-squamous cell carcinoma and lymph node metastasis were lower than the patients with age〈 45 years of age,hemoglobin level ≥110 g / L before the treatment,FIGO stage Ⅰ,myometrial invasion 〈1 /2,no parametrial invasion,without lymph vascular space invasion,tumor diameter〈 4 cm,squamous cell carcinoma,without lymph-node metastasis patients（ P 〈0. 05）. Hemoglobin level before the treatment,lymphatic vascular space invasion,non-squamous cell carcinoma and lymph node metastasis were the independent predictors of 5-year survival rate of patients with cervical cancer（ P 〈0. 05）. Conclusions Hemoglobin level before the treatment,FIGO stage,parametrial invasion,lymph-vascular space invasion,tumor diameter were the independent factors of cervical lymph node metastasis. Hemoglobin level before the treatment,lymphatic vascular space invasion,non-squamous cell carcinoma and lymph node metastasis were independent predictors of 5-year survival rate of patients with cervical cancer.