局部晚期宫颈鳞癌淋巴结转移规律及预后评价

Lymph node metastasis and prognosis in locally advanced squamous cell carcinoma of the cervix

目的:探讨局部晚期宫颈鳞状细胞癌的淋巴结转移规律、影响因素及其与预后的关系。方法:收集2008年1月至2017年12月在广西医科大学第四附属医院行宫颈癌根治术治疗、病历资料完整的306例局部晚期宫颈鳞状细胞癌患者为研究对象,记录其淋巴结转移情况,总结淋巴结转移模式,分析不同淋巴结转移模式的影响因素及其与预后的关系。结果:306例局部晚期宫颈鳞状细胞癌患者中,141例(46.1%)发生淋巴结转移,其中,阶梯式淋巴结转移者101例(71.6%),跳跃式淋巴结转移者40例(28.4%)。Logistic单因素回归分析显示:FIGO分期晚(OR=2.936;95%CI:1.955~4.411)、脉管转移(OR=2.441;95%CI:1.539~3.874)、宫旁浸润(OR=1.902;95%CI:1.084~3.337)、分化程度低(OR=1.552;95%CI:1.119~2.153)为淋巴结转移高危因素(P<0.05),而宫旁浸润者(OR=2.540;95%CI:1.148~5.621)发生跳跃式淋巴结转移的风险增加(P<0.05)。病例随访时间1~11年,淋巴结阴性者总生存时间较淋巴结阳性者长,而阶梯式淋巴结转移者总生存时间较跳跃式式淋巴结转移者长(P<0.05)。结论:淋巴结转移模式对宫颈鳞状细胞癌预后有预测价值,可为个体化治疗提供线索。

Objective:To investigate the lymph node metastasis of locally advanced squamous cell carcinoma of the cervix,and study the relationship of the influencing factors with prognosis.Methods:A total of 306 patients with locally advanced squamous cell carcinoma of the cervix,who underwent radical resection of cervical cancer at the Fourth Affiliated Hospital of Guangxi Medical University from Jan.2008 to Dec.2017 with complete medical records,were enrolled as the research subjects.The condition of lymph node metastasis was recorded,the lymph node metastasis patterns were summarized,and the influencing factors of different patterns of lymph node metastasis and their relationship with prognosis were analyzed.Results:Among 306 patients with locally advanced squamous cell carcinoma of the cervix,141(46.1%)patients had lymph node metastasis,including 101(71.6%)with stepwise lymph node metastasis and 40(28.4%)with skipped lymph node metastasis.Logistic univariate regression analysis showed:clinical stage(OR=2.936;95%CI:1.955-4.411),vascular positive(OR=2.441;95%CI:1.539-3.874),parauterine infiltration(OR=1.902;95%CI:1.084-3.337),and poor differentiation(OR=1.552;95%CI:1.119-2.153)were high risk factors for lymph node metastasis(P<0.05),and the risk of skipping lymph node metastasis was increased in those with parauterine infiltration(OR=2.540;95%CI:1.148-5.621)(P<0.05).The follow-up of 1 to 11 years showed that the total survival time of patients with negative lymph node was longer than that of patients with positive lymph node,and the total survival time of patients with stepwise lymph node metastasis was longer than that with skipped lymph node metastasis(P<0.05).Conclusion:The lymph node metastasis pattern has predictive value for the prognosis of squamous cell carcinoma of the cervix and can provide clues for individualized treatment.