局部晚期宫颈癌淋巴结转移的危险因素及预后分析

Risk factors for lymph node metastasis in locally advanced cervical cancer and their impact on prognosis

目的探讨局部晚期宫颈癌(LACC)淋巴结转移发生的高危因素及其对预后的影响。方法回顾性分析97例ⅠB2~ⅣA期LACC病人的临床资料,其中发生淋巴结转移55例。应用Logistics回归分析淋巴结转移的高危因素,采用Kaplan-Meier曲线和Log-rank检验分析淋巴结转移及其高危因素对无进展生存期(PFS)的影响。结果单因素分析表明,淋巴结转移阳性组和阴性组年龄、FIGO分期、鳞状细胞癌抗原(SCC)水平、糖类抗原125(CA125)、白细胞计数、血红蛋白、中性粒细胞计数、肿瘤大小以及间质浸润深度差异均有统计学意义(t=-3.157~2.173,U=12.314~1569.000,P<0.05)。多因素分析显示,FIGO分期(OR=3.204,95%CI=2.423~6.153,P=0.004)、SCC水平(OR=1.050,95%CI=1.009~1.092,P=0.017)、肿瘤大小(OR=1.045,95%CI=1.015~1.076,P=0.003)是淋巴结转移的独立危险因素。生存分析显示,淋巴结转移是PFS的影响因素(HR=3.944,95%CI=1.744~8.920,P=0.001);FIGO分期(HR=2.749,95%CI=1.216~6.215,P=0.015)、SCC水平(HR=20.552,95%CI=6.419~65.796,P<0.001)、肿瘤大小(HR=9.384,95%CI=2.614~33.687,P<0.001)对LACC的PFS具有很好的风险分层价值。结论FIGO分期、SCC水平和肿瘤大小是LACC淋巴结转移的独立危险因素。

Objective To investigate the high-risk factors for lymph node metastasis in locally advanced cervical cancer(LACC)and their impact on prognosis.Methods A retrospective analysis was performed for the clinical data of 97 patients with stageⅠB2-ⅣA LACC,among whom 55 patients experienced lymph node metastasis.A Logistic regression analysis was used to investigate the high-risk factors for lymph node metastasis,and the Kaplan-Meier curve and the Log-rank test were used to investigate the impact of lymph node metastasis and its high-risk factors on progression-free survival(PFS).Results The univariate analysis showed that there were significant differences between the positive lymph node metastasis group and the negative group in age,International Federation of Gynecology and Obstetrics(FIGO)stage,squamous cell carcinoma antigen(SCCA),carbohydrate antigen 125,white blood cell count,hemoglobin,neutrophil count,tumor size,and depth of stromal invasion(t=-3.157 to 2.173,U=12.314-1569.000,P<0.05).The multivariate analysis showed that FIGO stage(OR=3.204,95%CI=2.423-6.153,P=0.004),SCCA level(OR=1.050,95%CI=1.009-1.092,P=0.017),and tumor size(OR=1.045,95%CI=1.015-1.076,P=0.003)were independent risk factors for lymph node metastasis.The survival analysis showed that lymph node metastasis(HR=3.944,95%CI=1.744-8.920,P=0.001)was an influencing factor for PFS,and in addition,FIGO stage(HR=2.749,95%CI=1.216-6.215,P=0.015),SCCA level(HR=20.552,95%CI=6.419-65.796,P<0.001),and tumor size(HR=9.384,95%CI=2.614-33.687,P<0.001)had a good risk stratification value for PFS in LACC.Conclusion FIGO stage,SCCA level,and tumor size are independent risk factors for lymph node metastasis in LACC.