淋巴结平均直径对不伴淋巴结转移宫颈癌患者预后的影响

Effect of mean lymph node diameter on prognosis of cervical cancer patients without lymph node metastasis

目的:探讨Ⅰb~Ⅱa期不伴淋巴结转移宫颈癌患者的淋巴结平均直径与临床病理资料关系及其对预后的影响。方法:回顾分析2012年至2015年联勤保障部队第909医院收治的176例宫颈癌患者的临床病理资料,分析淋巴结平均直径与患者年龄、肿瘤分期、肿瘤直径、病灶类型、病理类型、浸润深度、脉管浸润、分化程度、累及阴道、淋巴结清扫数之间的关系。logistics多因素分析淋巴结平均直径大小影响因素;单因素和多因素Cox回归分析5年无复发生存率的影响因素;Kaplan-Meier生存分析验证影响因素对5年无复发生存率的影响。结果:肿瘤非外生型、肿瘤直径>4cm、浸润深度>1/2全层、脉管浸润阳性患者的淋巴结平均直径增大(P<0.05)。logistics多因素分析发现,肿瘤直径>4cm(OR=3.444,95%CI为1.636~7.250)、浸润深度>1/2全层(OR=1.491,95%CI为1.215~3.109)、脉管浸润阳性(OR=4.592,95%CI为1.596~10.781)是淋巴结平均直径增大的独立影响因素;脉管浸润阳性(OR=0.704,95%CI为0.452~0.824)、淋巴结平均直径>6.24mm(OR=0.668,95%CI为0.376~0.846)是肿瘤复发独立危险因素。Kaplan-Meier生存分析发现,脉管浸润阳性和阴性患者的5年无复发生存率分别为69.33%和88.11%,差异有统计学意义(P=0.001);淋巴结平均直径>6.24mm和≤6.24mm患者的5年无复发生存率分别为73.52%和89.18%,差异有统计学意义(P=0.023)。结论:Ⅰb~Ⅱa期不伴淋巴结转移宫颈癌患者的淋巴结平均直径增大(>6.24mm)与肿瘤大小、浸润深度和脉管侵犯相关,淋巴结直径增大是肿瘤复发转移的独立危险因素,在判断预后和制定个体化治疗方案方面可能具有一定的临床意义。

Objective:To explore the relationship between the average diameter of lymph nodes and the clinicopathological characteristics and prognosis of stageⅠb~Ⅱa cervical cancer without lymph node metastasis.Methods:Retrospective study was conducted based on the medical records of 176 patients with cervical cancer who underwent surgery in the 909th Hospital of Joint Logistics Support Force from 2012 to 2015.The average diameter of lymph node,tumor stage,tumor diameter,lesion type,pathological type,depth of invasion,vascular invasion,differentiation degree,vagina involvement,and number of lymph node dissection were collected.logistic multivariate analysis was used to analyze the influencing factors of the average diameter of lymph nodes.Univariate and Cox multivariate regression analysis were used to analyze the influencing factors of 5-year recurrence-free survival rate.Kaplan-Meier survival analysis was used to verify the influence of influencing factors on 5-year recurrence-free survival.Results:By univariate analysis,non-exogenous tumor type,tumor diameter>4cm,invasion depth>1/2 full layer and positive vascular invasion increased were closely related to the average lymph node diameter,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that there were independent risk factors including tumor diameter>4cm(OR=3.444,95%CI=1.636~7.250),invasion depth>1/2 full layer(OR=1.491,95%CI=1.215~3.109),positive vascular invasion(OR=4.592,95%CI=1.596~10.781).Cox multivariate regression analysis of independent risk factors for tumor recurrence included positive vascular infiltration(OR=0.704,95%CI=0.452~0.824)and mean lymph node diameter>6.24mm(OR=0.668,95%CI=0.376~0.846).Kaplan-Meier survival analysis showed that the 5-year recurrence-free survival rate of patients with positive vascular invasion was lower than that of patients with negative vascular invasion(69.33%vs 88.11%,P<0.05).The 5-year recurrence-free survival rate of patients with lymph node diameter>6.24mm was lower than that of patients with lymph node diameter≤6.24mm(73.52%vs 89.18%,P<0.05).Conclusions:For patients with stageⅠb~Ⅱa cervical cancer without lymph node metastasis,the average diameter of lymph nodes is correlated with tumor size,depth of invasion and vascular invasion.In addition,increased lymph node diameter is an independent risk factor for tumor recurrence and metastasis.This may provide a basis for the prognosis of patients.