早期宫颈腺癌淋巴脉管间隙浸润相关临床病理因素及生存分析

Relationship among lymphovascular space invasion with clinicopathological factors and survival analysis in early cervical adenocarcinoma

目的:研究早期宫颈腺癌淋巴脉管间隙浸润(LVSI)与临床病理因素及预后的关系,并探讨早期宫颈腺癌的预后影响因素。方法:回顾分析2006年1月至2018年12月于北京大学第一医院行手术治疗的128例Ia1~IIa2期宫颈腺癌病例,分为LVSI(+)组和LVSI(-)组,分析早期宫颈腺癌LVSI相关影响因素及预后影响因素。结果:单因素分析显示,LVSI与HPV高危型感染、分化程度、FIGO分期、肿瘤直径、宫颈深间质浸润、淋巴结转移和手术切缘阳性有关(P<0.05)。多因素分析显示,LVSI与FIGO分期、宫颈深间质浸润和淋巴结转移相关(P<0.05)。LVSI(+)组和LVSI(-)组的5年无复发率分别为70.40%和84.81%,5年生存率分别为73.36%和90.62%。LVSI(+)组的总生存时间(OS)显著低于LVSI(-)组(P=0.004),但无复发生存时间(DFS)两组无统计学差异(P=0.082)。术后放疗可显著改善LVSI(+)组5年无复发率(P=0.046)。单因素分析显示,分化程度、宫颈间质浸润、LVSI、淋巴结转移和术后治疗影响总生存时间。COX多因素分析显示,宫颈间质浸润、LVSI和淋巴结转移是早期宫颈腺癌患者生存时间的独立预后因素。结论:LVSI与早期宫颈腺癌多种临床病理因素相关,是早期宫颈腺癌总生存时间的独立影响因素,临床治疗过程中应引起高度重视。

Objective:To investigate the relationship among lymphovascular space invasion(LVSI)with clinicopathological factors and prognosis in early cervical adenocarcinoma and to explore the prognostic factors of early cervical adenocarcinoma.Methods:A retrospective analysis was conducted on 128 cases of Ia1~IIa2 cervical adenocarcinoma treated by surgery at the Peking University First Hospital between Jan.2006 and Dec.2018.Patients were divided into LVSI(+)group and LVSI(-)group,the influence of clinicopathological features on LVSI and prognostic factors were analyzed.Results:Univariate analysis showed that LVSI was associated with high risk HPV infection,histological grade,FIGO stage,tumor diameter,cervical stromal invasion,lymph node metastasis and positive surgical margins(P<0.05).Independent related factors for positive LVSI were FIGO stage,deep cervical stromal invasion and lymph node metastasis by the Logistic regression analysis(P<0.05).The 5-year disease free survival(DFS)rate of LVSI(+)and LVSI(-)patients was 70.40%and 84.81%,the 5-year overall survival(OS)rate of LVSI(+)and LVSI(-)patients was 73.36%and 90.62%respectively.The OS in LVSI(+)group was significantly lower than that in LVSI(-)group(P=0.004),but there was no significant difference in DFS between the two groups(P=0.082).Radiotherapy after surgery could significantly improve the 5-year DFS rate of LVSI(+)patients(P=0.046).Univariate survival analysis showed that histological grade,cervical stromal invasion,LVSI,lymph node metastasis and postoperative treatment were significantly related to the OS(P<0.05).The COX multivariate analysis showed that cervical stromal invasion,LVSI and lymph node metastasis were independent prognostic factors for the OS(P<0.05).Conclusions:The presence of LVSI is related to many clinicopathological factors,and LVSI is an independent influencing factor for the OS.LVSI should be paid more attention in clinical treatments.