早期子宫颈腺癌盆腔淋巴结转移高危因素分析

The Analysis of High-Risk Factors of Pelvic Lymph Node Metastasis in Early Stage Cervical Adenocarcinoma

目的:探讨早期子宫颈腺癌盆腔淋巴结转移高危因素,为临床是否切除盆腔淋巴结提供参考。方法:收集418例早期子宫颈腺癌患者临床病理资料,进行单因素及多因素Logistic回归分析盆腔淋巴结转移的高危因素。结果:患者发病年龄18~69岁,孕次0~11次,产次0~5次,体质量指数15.15~32.42 kg/m^2。临床表现以接触性出血及阴道不规则流血多见,分别占43.78%(183/418)及31.10%(130/418)。临床分期以ⅠB1期为主,有244例(58.37%);组织学类型以子宫颈腺癌普通型为主,有219例(52.39%)。患者盆腔淋巴结转移率为17.46%(73/418)。单因素分析发现术前未行新辅助化疗、临床分期、组织学类型、肿瘤直径、子宫颈间质浸润深度、淋巴脉管间隙浸润、宫旁浸润、切缘浸润、阴道浸润、宫体浸润、输卵管转移是盆腔淋巴结转移的影响因素(P<0.05)。多因素Logistic回归分析发现,FIGO临床分期Ⅱ期(OR 3.658,95%CI 1.950~6.680)、子宫颈间质浸润深度≥1/2(OR 4.962,95%CI 2.110~11.669)、淋巴脉管间隙浸润(OR 2.279,95%CI 1.190~4.363)、宫体浸润(OR 2.124,95%CI 1.115~4.047)、输卵管转移(OR 6.429,95%CI 1.473~28.063)是盆腔淋巴结转移的高危因素(P<0.05)。结论:早期子宫颈腺癌患者中,FIGO临床分期Ⅱ期、子宫颈间质浸润深度≥1/2、淋巴脉管间隙浸润、宫体浸润、输卵管转移的子宫颈腺癌患者发生盆腔淋巴结转移可能性大,应行盆腔淋巴结切除术。

Objective:To explore the high-risk factors of pelvic lymph node metastasis in early stage cervical adenocarcinoma patients,and to provide reference for clinical resection of pelvic lymph nodes.Methods:The clinicopathological data of 418 patients with early stage cervical adenocarcinoma were collected.The high-risk factors of pelvic lymph node metastasis were analyzed by univariate and logistic regression analysis.Results:The age of the patients ranged from 18 to 69 years old with the number of pregnancies ranged from 0 to 11 and births ranged from 0 to 5,and the body mass index ranged from 15.15 to 32.42 kg/m^2.Contact hemorrhage(43.78%,183/148)and irregular vaginal bleeding(31.10%,130/148)were the most common clinical manifestations,and the numbers were 183 and 130 cases respectively.The clinical stage was mainlyⅠB1,with 244 cases(58.37%)and the histological type was mainly endocervical adenocarcinomausual type,with 219 cases(52.39%).The rate of pelvic lymph node metastasis was 17.46%(73/418).Univariate analysis showed that without neoadjuvant chemotherapy,clinical stage,histological type,tumor diameter,cervical interstitial infiltration,lymphatic vessel space infiltration,parametrial infiltration,margin of incision infiltration,vaginal infiltration,uterine body infiltration and fallopian tube metastasis were the high-risk factors for pelvic lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that FIGO stageⅡ(OR 3.658,95%CI 1.950-6.680),cervical interstitial infiltration(≥1/2)(OR 4.962,95%CI 2.110-11.669),lymphatic vessel space infiltration(OR 2.279,95%CI 1.190-4.363),uterine body infiltration(OR 2.124,95%CI 1.115-4.047)and fallopian tube metastasis(OR 6.429,95%CI 1.473-28.063)were independent high-risk factors for pelvic lymph node metastasis(P<0.05).Conclusions:Cervical adenocarcinoma patients with FIGO stageⅡ,cervical interstitial infiltration(≥1/2),lymphatic vessel space infiltration,uterine body infiltration and fallopian tube metastasis were more likely to have pelvic lymph node metastasis,and pelvic lymphadenectomy should be performed.