子宫颈癌术后肝转移13例临床分析

Hepatic metastases after cervical cancer surgery:clinical analysis of 13 cases

目的探讨子宫颈癌术后肝转移患者的临床特点,并分析术后发生肝转移的危险因素及预后影响因素。方法收集2013年1月-2016年1月郑州大学第一附属医院行根治性手术的Ⅰa2~Ⅱb2期子宫颈癌患者共1312例,其中13例(0.99%,13/1312)术后发生肝转移。回顾性分析子宫颈癌术后肝转移患者的临床特点;对子宫颈癌术后发生肝转移的危险因素进行分析,单因素分析采用t检验、χ^2检验或秩和检验,多因素分析采用logistic回归法;采用Kaplan-Meier法进行生存分析,并采用log-rank检验对子宫颈癌术后肝转移患者的预后影响因素进行分析。结果(1)临床特点:13例子宫颈癌术后肝转移患者中,单纯肝转移3例,均无明显临床症状;伴肝周淋巴结转移2例,仅表现为腰痛;伴肝外多发转移8例,其临床症状与转移部位相关。9例术后肝转移患者有血清肿瘤标志物检测结果,其中5例(5/9)异常升高,异常指标主要为癌胚抗原(CEA)、CA125、CA199、CA72-4。子宫颈癌术后发生肝转移的中位时间为9个月(2~22个月);肝转移灶的中位最大直径为3.0 cm(1.9~6.5 cm)、中位数量为4个(1~9个),肝转移灶累及单叶者6例、双叶者7例。(2)术后发生肝转移的危险因素分析:单因素分析显示,病理类型、子宫颈浸润深度、淋巴脉管间隙浸润、淋巴结转移状态与子宫颈癌术后发生肝转移显著有关(P<0.05)。多因素分析显示,淋巴结有转移及病理类型为小细胞癌是影响子宫颈癌术后发生肝转移的独立危险因素(P<0.05)。(3)术后肝转移患者的预后影响因素分析:13例子宫颈癌术后肝转移患者中,随访期内9例死亡、4例存活,肝转移后的中位总生存时间为7个月(3~32个月)。单因素分析显示,伴肝外多发转移、肝转移后的治疗方式对子宫颈癌术后肝转移患者的预后有显著影响(P<0.05)。结论子宫颈癌术后肝转移均发生在术后2年内,淋巴结有转移、病理类型为小细胞癌的患者术后更易发生肝转移,伴肝外多发转移患者预后较差,针对子宫颈癌术后肝转移应综合分析后进行个体化治疗。

Objective To investigate the clinical characteristics of patients with hepatic metastasis after cervical cancer operation,and analyze the risk factors and prognostic factors of hepatic metastasis.Methods A total of 1312 patients with stageⅠa2-Ⅱb2 cervical cancer received radical surgery from January 2013 to January 2016 in the First Affiliated Hospital of Zhengzhou University were collected,of which 13 cases(0.99%,13/1312)had hepatic metastasis after operation.A retrospective analysis was conducted on clinical features of patients with hepatic metastasis after cervical cancer operation.T-test,chi-square test,rank sum test and logistic regression were used to analyze the risk factors of hepatic metastasis after surgery of cervical cancer operation.Kaplan-Meier method was used for survival analysis.Log-rank test was used for screening of prognostic factors in patients with postoperative hepatic metastasis.Results(1)Clinical features:there were 3 cases of simple hepatic metastasis without obvious clinical symptoms,2 patients with perihepatic lymph node metastasis showed only low back pain,8 patients with multiple extrahepatic metastases,and their clinical symptoms were related to the site of metastasis.Five cases out of 9(5/9)with liver metastasis had abnormal tumor marker results.The abnormal kinds of tumor markers were mainly carcinoembryonic antigen(CEA),CA125,CA199,and CA72-4.The interval time of hepatic metastasis after operation was 2-22 months.(2)Analysis of risk factors for hepatic metastasis:univariate analysis showed that lymph node metastasis,histological type,infiltration depth,and lymph-vascular space invasionwere associated with hepatic metastasis after cervical cancer surgery(P<0.05).Multivariate analysis showed that lymph node metastasis and small cell carcinoma were independent risk factors for postoperative hepatic metastasis(P<0.05).(3)Prognostic factors in patients with hepatic metastasis:among 13 patients with postoperative hepatic metastases from cervical cancer,9 died during the follow-up period and 4 survived.The median total survival time after hepatic metastases was 7 months(range 3-32 months).Univariate analysis showed that multiple extrahepatic metastases and treatment after hepatic metastasis had significant effects on the prognosis of patients with hepatic metastasis after cervical cancer operation(P<0.05).Conclusions The interval of hepatic metastasis after surgery for cervical cancer operation is within 2 years.Patients with lymph node metastasis and small cell carcinoma are more prone to postoperative hepatic metastasis.The prognosis of patients with extrahepatic multiple metastases is poor,and individualized treatment should be carried out after comprehensive analysis for patients with hepatic metastasis after cervical cancer operation.