早期宫颈癌淋巴脉管间隙浸润与临床病理因素及预后的关系

Relationship among Lymph Vascular Space Invasion with Clinicopathological Factors and Prognosis in Early Cervical Cancer

目的:研究早期宫颈癌淋巴脉管间隙浸润(LVSI)与临床病理因素及预后的关系,以指导早期宫颈癌的治疗并判断预后。方法:回顾性收集280例早期宫颈癌(ⅠA2~ⅡB)患者的临床及病理资料,所有患者2009年1月至2012年6月于大连市妇产医院初治手术治疗,术式为经腹或腹腔镜下广泛性子宫切除术+盆腔淋巴结切除术±腹主动脉旁淋巴结切除术。根据术后是否存在高危因素,进行辅助放疗或联合放化疗。采用单因素分析研究LVSI与各临床病理因素的关系,进一步对单因素分析结果中与LVSI关系显著的临床病理因素进行多因素分析,确定其独立的危险因素。绘制生存曲线,确定LVSI对患者生存的影响。结果:①单因素分析显示:LVSI与宫颈癌组织学类型、分化程度、淋巴结转移、浸润深度有关(P<0.05),与年龄、宫旁受累、病灶大小、FIGO分期无关(P>0.05);多因素分析显示LVSI是分化程度、淋巴结转移及浸润深度的独立危险因素(P<0.05)。②LVSI阳性患者的5年无病生存率为74%,总生存率为80%;LVSI阴性患者的5年无病生存率及总生存率均为93%(P<0.05)。结论:LVSI阳性一定程度上能更早地提示淋巴结转移的潜在风险,是发生淋巴结转移的独立危险因素,并能显著降低早期宫颈癌患者的5年无病生存率及总生存率。LVSI阳性早期宫颈癌患者可能浸润深度更深、分化程度更差,但需更多研究证实。

Objective：To investigate the relationship among lymph vascular space invasion （LVSI） with clinico- pathological factors and prognosis in early cervical cancer（CC）. Methods： Retrospective analysis was conducted on 280 cases of early CC that were surgically treated at Dalian Maternal and Child Health Care hospital between January 2009 and June 2012. Univafiate analysis was performed to study the relationship between LVSI and clini- copathological factors,the clinicopathological factors statistically associated with LVSI in univariate analysis were studied by multivariate analysis to identify the independent risk factors of LVSI. Results： ①Univariate analysis showed that histological type, histological differentiation, lymph node metastasis and cervical stromal invasion depth were significantly correlated with LVSI （P 〈 0.05）. Multivariate analysis showed that LVSI was an independent risk factor for differentiation, lymph node metastasis, and the depth of invasion. ②The 5 - year disease free survival（DFS） of LVSI positive patients was 74%, and the overall survival（OS） was 80%. The 5 - year DFS and OS of LVSI negative patients were 93% （ P 〈 0.05）. Conclusions： LVSI can reflect the potential risk of lymph node metastasis to some extent. LVSI is the independent risk factor of lymph node metastasis and can significantly reduce the DFS and OS. Patients with LVSI positive may have deeper infiltration and poorer differentiation,but more studies are needed to confirm it.