子宫颈鳞状细胞癌嗜神经侵袭与预后的相关性分析

Correlation analysis of perineural invasion and prognosis in cervical squamous carcinoma

目的探讨子宫颈鳞状细胞癌嗜神经侵袭(PNI)与患者临床病理特征和预后的关系.方法回顾性分析2010年1月至2013年12月在山西省肿瘤医院行子宫广泛性切除+盆腔淋巴结切除术治疗的256例ⅠB1~ⅡA2期子宫颈鳞状细胞癌患者的临床病理资料,镜下观察病理切片肿瘤区域的PNI情况,分析PNI与患者临床病理特征的关系及对术后5年生存的影响.结果256例子宫颈鳞状细胞癌患者中22例(8.6%)出现PNI.PNI阳性与肿瘤分期、浸润深度、脉管间隙浸润、淋巴结转移均有关(均P<0.05).多因素logistic回归分析显示,淋巴结转移是影响PNI发生的独立危险因素(OR=3.89,95%CI 1.50~10.12,P=0.005),间质浸润深度>1/2可能是影响PNI发生的独立危险因素(OR=7.30,95%CI 0.91~58.74,P=0.062).256例子宫颈鳞状细胞癌患者5年总生存率为89.9%,PNI阳性患者的5年总生存率(50.3%)低于PNI阴性患者(93.4%).Cox回归分析显示,PNI阳性是影响患者5年总生存的危险因素(HR=9.73,95%CI 4.31~21.98,P<0.01);校正相关临床病理特征后,PNI阳性仍是影响患者5年总生存的危险因素(HR=8.12,95%CI 2.47~26.73,P=0.001).结论ⅠB1~ⅡA2期子宫颈鳞状细胞癌PNI的发生与临床分期、浸润深度、脉管间隙浸润及淋巴结转移相关,PNI阳性可能是影响子宫颈鳞状细胞癌预后的新的危险因素.

Objective To investigate the relationship between perineural invasion (PNI) and clinicopathological features as well as the prognosis of cervical squamous carcinoma. Methods The clinico-pathological data of 256 patients with cervical squamous carcinoma (ⅠB1-ⅡA2) treated with extensive resection and pelvic lymphadenectomy in Shanxi Provincial Cancer Hospital from January 2010 to December 2013 were retrospectively analyzed. PNI of tumor area in the pathological sections was observed by using microscope. The relationship between PNI and clinicopathological features was analyzed. The effect of PNI on postoperative 5-year survival was also analyzed. Results There were 22 (8.6%) cases of PNI among 256 patients with cervical squamous carcinoma. PNI-positive had a relation with tumor stage, depth of invasion, lymphovascular space invasion (LVSI), and lymph node metastasis (all P < 0.05). Multivariate logistic regression showed that positive lymph node metastasis was an independent risk factor for PNI (OR = 3.89, 95% CI 1.50-10.12, P =0.005);infiltration depth > 1/2 might be an independent risk factor for PNI (OR = 7.30, 95% CI 0.91-58.74, P = 0.062). The 5-year total survival rate was 89.9% for 256 patients with cervical squamous carcinoma. And the 5-year total survival rate of PNI-positive patients was lower than that of PNI-negative patients (50.3% vs. 93.4%). Cox regression showed that PNI-positive was a risk factor for 5-year total survival (HR = 9.73, 95%CI 4.31-21.98, P < 0.01);after adjusting the relevant clinicopathological features, PNI-positive was still a risk factor of 5-year total survival (HR = 8.12, 95% CI 2.47-26.73, P = 0.001). Conclusions The occurrence of PNI in cervical squamous carcinoma of ⅠB1 -ⅡA2 is associated with clinical stage, depth of invasion, LVSIand lymph node metastasis. PNI-positive may be a new risk factor for the prognosis of cervical squamous carcinoma.