ⅠB～ⅡB期宫颈癌盆腔淋巴结转移的影响因素分析

Analysis of Influencing Factors Associated with Pelvic Lymph Node Metastasis in Stage Ⅰ B to Ⅱ B Cervical Cancer

目的:探讨ⅠB~ⅡB期宫颈癌盆腔淋巴结转移的影响因素。方法:回顾性分析630例行手术治疗的ⅠB~ⅡB期宫颈癌患者的临床资料,了解盆腔淋巴结的转移情况,采用χ2检验、Mann-WhitneyU检验和多因素Logistic回归对宫颈癌盆腔淋巴结转移影响因素进行分析。结果:总体盆腔淋巴结转移率为27.9%(176/630),转移淋巴结754枚,其中74.8%(564/754)分布于宫旁/闭孔区。单因素分析表明,临床分期、细胞分化、宫体受累、脉管间隙受累、宫颈间质浸润深度、鳞状细胞癌抗原(SCC-Ag)和癌抗原125(CA125)水平与盆腔淋巴结转移相关(均P<0.05)。多因素分析表明,低细胞分化(OR=3.874,95%CI:1.100~13.646,P=0.035)、深1/3宫颈间质浸润(OR=2.735,95%CI:1.675~4.466,P<0.001)和脉管间隙受累(OR=73.822,95%CI:22.304~244.336,P<0.001)是盆腔淋巴结转移的独立危险因素。结论:宫颈癌盆腔淋巴结转移以宫旁/闭孔区最易受累,低细胞分化、深宫颈间质浸润、脉管间隙受累发生盆腔淋巴结转移风险较高,在临床治疗中,应确保宫旁切除范围,并实施系统性淋巴结清扫。

Objective:To investigate the influencing factors associated with pelvic lymph node metastasis(PLNM)in stageⅠB toⅡB cervical cancer.Methods:Clinical data of 630 patients with stageⅠB toⅡB cervical cancer treated with surgery were retrospectively studied.The PLNM condition of each patient was abstracted and the influencing factors of PLNM were analyzed byχ2,Mann-Whitney U test and multivariate logistic regression analysis.Results:27.9%(176/630)patients had PLNM.Among 754 metastatic lymph nodes,74.8%(564/754)of them were located in parametrial/obturator region.Result of univariate analysis suggested clinical stage,cell differentiation,uterine involvement,lymphovascular space invasion(LVSI),depth of stromal invasion,the level of SCC-Ag and CA125 were associated with PLNM(both P<0.05).The multivariate analysis suggested low cell differentiation(OR=3.874,95%CI:1.100-13.646,P=0.035),deep 1/3 stromal invasion(OR=2.735,95%CI:1.675-4.466,P<0.001)and LVSI(OR=73.822,95%CI:22.304-244.336,P<0.001)were the independent risk factors of PLNM.Conclusions:Parametrial/obturator region are the most vulnerable areas of PLNM in cervical cancer.Patients with low cell differentiation,deep stromal invasion and LVSI are associated with a high risk of PLNM.In clinical treatment,surgeon should ensure the parametrial-excision range,and the implementation of systemic lymphadenectomy.