淋巴脉管间隙浸润对早期宫颈癌预后的影响分析

Analysis of the influence of lymphovascual space invasion on the prognosis of patients with early-stage cervical carcinoma

目的探讨淋巴脉管间隙浸润(LVSI)对早期宫颈癌预后的影响。方法回顾性分析2009年1月至2015年12月郑州大学第二附属医院经手术治疗的470例ⅠA2~ⅡA2期宫颈癌,分为LVSI阳性组和LVSI阴性组,比较两组间的临床病理特征,分析LVSI对早期宫颈癌预后的影响。结果 22例失访,有预后资料者共448例。单因素分析显示LVSI与组织学分级、宫颈间质浸润、宫旁浸润、阴道穹窿浸润、淋巴结转移有关,Logistic回归分析显示LVSI阳性与组织学低分化、深间质浸润、宫旁转移和淋巴结转移相关。55例复发病例中LVSI阳性21例(38.2%),393例未复发病例中LVSI阳性63例(16.0%)。50例死亡病例中LVSI阳性17例(34.0%),398例存活病例中LVSI阳性67例(16.8%),两组间差异均有统计学意义(Ρ=0.000,Ρ=0.003)。全组5年总生存率、无瘤生存率为87.9%、86.8%。单因素分析显示临床分期、组织学分级、宫颈间质浸润、宫旁浸润、阴道穹窿浸润、LVSI、淋巴结转移、LVSI和淋巴结转移和术后治疗影响5年总生存时间(OS)和无瘤生存时间(DFS)。COX多因素分析显示,宫颈间质浸润、组织学分级、淋巴结转移是5年OS、DFS的独立预后因素,阴道穹窿受侵是5年OS的独立预后因素,LVSI是5年DFS的独立预后因素。结论 LVSI与多种不良预后因素相关,是早期宫颈癌复发和转移的危险因素,LVSI是5年无瘤生存的独立影响因素,尚不能确定LVSI是早期宫颈癌5年总生存的独立影响因素。

Objective To explore the influence of lymphovascual space invasion on the prognosis of patients with earlystage cervical carcinoma.Methods A retrospective analysis of 470 cases of ⅠA2-ⅡA2 cervical carcinoma treated by surgery from January 2009 to December 2015 at the Second Affiliated Hospital of Zhengzhou University was divided into LVSI positive group and LVSI negative group. The clinicopathological features between the two groups were compared,and the influence of LVSI on the prognosis of early-stage cervical carcinoma was analyzed.Results Univariate analysis showed that LVSI was associated with histological grade,cervical stromal invasion,parametrial invasion,vaginal dome invasion,lymph node metastasis;the factors associated with positive LVSI were poor histological differentiation,deep cervical stromal invasion,parametrial invasion and lymph node metastasis by the Logistic regression analysis.There were 21 cases（38.2%）of LVSI positive in 55 cases of recurrent cases,63 cases（16.0%）of LVSI positive in 393 cases of non-recurrent cases;17 cases（34.0%）were LVSI positive in 50 cases of death,and 67（16.8%）were LVSI positive in 398 cases of survival;the differences were statistically significant（Ρ=0.000;Ρ=0.003）.The 5-year overall survival（OS）and disease-free survival（DFS）rates for the whole group were 87.9% and 86.8%.Univariate survival analysis showed that the clinical stage,histological grade,cervical stromal invasion,parametrial invasion,vaginal dome invasion,LVSI,lymph node metastasis,LVSI lymph node metastasis and postoperative treatment were significantly related to the 5-yeas overall survival and disease-free survival rates.The COX multivariate analysis showed that cervical stromal invasion,histological grade and lymph node metastasis were independent prognostic factors for OS and DFS;vaginal dome invasion was an independent prognostic factor of OS;LVSI was an independent factor of DFS.Conclusion The presence of LVSI is related to many unfavorable prognostic factors,and LVSI is a risk factor of early recurrence and metastasis of cervical carcinoma. LVSI is an independent influencing factor for 5-year disease-free survival.Whether LVSI is an independent prognostic factor in the 5-years overall survival of early-stage cervical carcinoma cannot be determined currently.