218例宫颈癌患者腹主动脉旁淋巴结转移的危险因素探究

Risk Factors of Para-aortic Lymph Nodes Metastasis:Analysis of 218 Patients with Cervical Carcinoma

目的分析宫颈癌腹主动脉旁淋巴结转移的危险因素,探究腹主动脉旁淋巴结清扫术的手术指征。方法回顾性分析2015年1月至2016年6月在华中科技大学同济医学院附属同济医院接受广泛子宫全切及系统性盆腔、腹主动脉旁淋巴结清扫治疗的ⅠB1～ⅡB期宫颈癌患者218例。通过单因素分析与多因素回归分析探讨影响腹主动脉旁淋巴结阳性的高危因素。结果腹主动脉旁淋巴结总转移率为4.59%(10/218)。单因素分析显示,病理分化程度(P=0.029)和盆腔淋巴结转移(P<0.01)在转移组和非转移组差异有统计学意义。在40例盆腔淋巴结阳性的亚组中,盆腔淋巴结单/双侧转移(P=0.001)和淋巴结阳性个数(P=0.008)均与腹主动脉旁淋巴结转移相关。多因素分析显示盆腔淋巴结阳性(P<0.01)和盆腔淋巴结双侧转移(P=0.045)是宫颈癌腹主动脉旁淋巴结转移的独立危险因素。结论盆腔淋巴结阳性,尤其是双侧均阳性的宫颈癌患者建议完善腹主动脉旁淋巴结清扫手术,或放疗制定放射野时须充分考虑合并腹主动脉旁淋巴结转移的可能性,如术中探查见盆腔淋巴结增大,必要时需行淋巴结快速病检以明确有无转移,从而协助判断是否需扩大手术范围。

Objective To investigate the risk factors of para-aortic lymph nodes(PALN)metastasis in cervical carcinoma,and explore the indications of surgical radical dissection of para-aortic lymph node.Methods Two hundred and eighteen patients with stageⅠB1toⅡB cervical cancer undergoing radical hysterectomy,pelvic lymphadenectomy and para-aortic lymphadenectomy were included in our retrospective study.Univariate analysis was performed using Fisher exact probability method and Pearson chi square test.High risk factors of PALN metastasis was analyzed by unilabiate analysis and Logistic regression analysis.Results The metastasis rate of PALN was4.59%(10/218).Univariate analysis showed significant differences in differentiation(P=0.029)and pelvic lymph node(PLN)metastasis(P<0.01)between PALN metastasis group and non-metastasis group.In PLN positive subgroup(40patients),single/bilateral PLN metastasis(P=0.001)and the number of positive PLN(P=0.008)were correlated with PALN metastasis.Logistic regression results showed that positive PLN(P<0.01)and bilateral PLN metastasis(P=0.045)were independent risk factors for PALN in cervical carcinoma.Conclusion Patients with PLN metastasis,especially bilateral metastasis,should receive para-aortic lymph node dissection.Possibility of PALN metastasis should be considered in radiotherapy and the radiation scope should correspond to that.If pelvic lymph nodes are observed enlarged during surgery,rapid pathological examination should be performed,in order to delay the progression of distant metastasis or tumor recurrence.