不同亚型宫颈癌根治术后淋巴结转移的风险因素及时间分布

Risk factors and time distribution of lymph node metastasis after radical resection of different subtypes of cervical cancer

目的探究不同亚型宫颈癌(CCA)根治术后淋巴结转移的风险因素及时间分布。方法选择2017年2月至2020年2月于甘肃省肿瘤医院接受根治术治疗的162例CCA患者为研究对象,根据病理类型分为鳞癌、腺癌、腺鳞癌、特殊类型癌4种亚型,探究不同亚型与临床特征的关系,并分析不同亚型的CCA根治术后淋巴结转移的时间分布规律。依据随访期间是否发生淋巴结转移分为转移组(n=46)和未转移组(n=116),分析患者发生淋巴结转移的影响因素,使用逐步回归方法进一步筛选与淋巴结转移关联最重要的临床因素,用于构建列线图预测模型并验证。结果不同亚型的患者在肿瘤直径、临床分期、组织学分级、淋巴结转移、肌层浸润深度、脉管癌栓阳性方面的差异明显(P<0.05)。特殊类型癌、肿瘤直径、临床分期、组织学分级、肌层浸润深度、脉管癌栓阳性是CCA患者根治术后淋巴结转移的危险因素(P<0.05)。逐步回归分析筛选出特殊类型癌、肿瘤直径、组织学分级及临床分期4个因素与淋巴结转移关联最大,将4个因素纳入并构建了列线图,模型具有较好的区分度和准确性。CCA根治术后总淋巴结转移风险时间呈双峰分布,转移高峰分别在术后第12个月和第30个月。结论特殊类型癌CCA患者根治术后更易发生淋巴结转移,术后第12个月和第30个月风险最高。

Objective To explore the risk factors and time distribution of lymph node metastasis after radical treatment for different subtypes of cervical cancer(CCA).Methods A total of 162 patients with CCA who received radical surgery in Gansu Provincial Cancer Hospital from February 2017 to February 2020 were selected as the study objects,and were divided into 4subtypes of squamous cell carcinoma,adenocarcinoma,adeno-squamous cell carcinoma and special type cancer according to pathological types.The relationship between different subtypes and clinical characteristics was explored,and the time distribution of lymph node metastasis after radical surgery for different subtypes of CCA was analyzed.According to whether lymph node metastasis occurred during the follow-up period,patients were divided into metastatic group(n=46)and non-metastatic group(n=116).Factors affecting the occurrence of lymph node metastasis were analyzed,and the most important clinical factors associated with lymph node metastasis were further screened by stepwise regression method,which was used to construct and verify the Nomogram prediction model.Results Patients with different subtypes had significant differences in tumor diameter,clinical stage,histological grade,lymph node metastasis,depth of muscular invasion and positive vascular cancer thrombus(P<0.05).Specific type of cancer,tumor diameter,clinical stage,histological grade,depth of muscular invasion,and positive thrombus were the risk factors for lymph node metastasis in patients with CCA after radical surgery(P<0.05).By stepwise regression analysis,four factors were found to be the most correlated with lymph node metastasis,including special type of cancer,tumor diameter,histological grade and clinical stage.The four factors were included and a column diagram was constructed,which showed good differentiation and accuracy of the model.The risk time of total lymph node metastasis after radical CCA surgery was bimodal,and the peak of metastasis was 12 months and 30 months.Conclusion Patients with CCA were more likely to develop lymph node metastasis after radical surgery,and the risk was highest at 12 and 30 months after surgery.