宫颈癌腹主动脉旁淋巴结转移与病理特征的关系

Relationship between metastasis in the para-aortic lymph nodes of cervical cancer and pathological features

目的探讨宫颈癌腹主动脉旁淋巴结(PALN)转移的发生情况及其相关危险因素。方法回顾性分析2002年1月30日至2021年1月6日于复旦大学附属妇产科医院行宫颈癌根治术+盆腔和PALN切除术的宫颈癌患者的病理资料(727例),采用受试者工作特征(ROC)曲线确定肿瘤长径预测宫颈癌患者PALN转移的最佳临界值,影响因素分析采用logistic回归分析。结果727例宫颈癌患者中,123例(16.9%)发生PALN转移。ROC曲线显示,肿瘤长径为4.2 cm时,预测PALN转移灵敏度为61.8%,特异度为64.9%。单因素分析显示,肿瘤长径、浸润深度>2/3肌层、脉管内癌栓、宫体受侵、阴道受侵、宫旁受侵、手术切缘阳性、卵巢转移、输卵管转移、盆腔淋巴结转移、髂总淋巴结转移与PALN转移有关(均P<0.05)。以2.0 cm为肿瘤长径最佳临界值时,logistic多因素回归分析显示,宫旁受侵(OR=2.210,95%CI:1.174~4.162,P=0.014)、盆腔淋巴结转移(OR=12.891,95%CI:2.902~57.268,P=0.001)、髂总淋巴结转移(OR=9.293,95%CI:4.597~18.787,P<0.001)是PALN转移的独立影响因素,肿瘤长径>2.0 cm与PALN转移无关(P=0.807)。以4.2 cm为肿瘤长径最佳临界值时,logistic多因素回归分析显示,肿瘤长径>4.2 cm(OR=2.020,95%CI:1.061~3.847,P=0.032)、宫旁受侵(OR=2.148,95%CI:1.134~4.070,P=0.019)、盆腔淋巴结转移(OR=11.334,95%CI:2.534~50.704,P=0.001)、髂总淋巴结转移(OR=9.903,95%CI:4.831~20.297,P<0.001)是PALN转移的独立影响因素。结论原发肿瘤>4.2 cm、宫旁受侵、盆腔淋巴结转移和髂总淋巴结转移是宫颈癌PALN转移的独立危险因素,初次手术前应充分评估肿瘤长径和髂总淋巴结转移情况,术后综合盆腔淋巴结和宫旁转移情况,有助于减小误诊率和漏诊率,并为个体化治疗和预后判断提供依据。

Objective To investigate the incidence and the related risk factors of para-aortic lymph node metastasis in cervical cancer.Methods The pathological data of 727 patients with cervical cancer who underwent radical hysterectomy and pelvic and para-aortic lymph node dissection were retrospectively analyzed.The relative postoperative pathological parameters of para-aortic lymph node metastasis were statistically analyzed.Results Among the 727 patients with cervical cancer,123(16.9%)had para-aortic lymph node metastasis.Univariate analysis showed that the tumor size,the depth of muscular invasion,the vessel invasion,the uterine body invasion,the vaginal invasion,the parametrial invasion,positive surgical margin,the ovary metastasis,the fallopian tubes metastasis,the pelvic lymph node metastasis,and the common iliac lymph node metastasis were associated with para-aortic lymph node metastasis.While the multivariate logistic regression analysis showed that the diameter of primary tumor>4.2 cm,the parametrial invasion,the pelvic lymph node metastasis,and the common iliac lymph node metastasis were the independent risk factors of para-aortic lymph node metastasis.Conclusions The diameter of primary tumor>4.2 cm,the parametrial invasion,the pelvic lymph node metastasis,and the common iliac lymph node metastasis are the independent risk factors of para-aortic lymph node metastasis in cervical cancer.The tumor size and the common iliac lymph node status should be fully evaluated before the initial operation.Additionally,assessment of the postoperative pelvic lymph node status and the parametrial status will help reduce the rate of misdiagnosis and missed diagnosis,providing a basis for individualized treatment and prognostic judgment.