淋巴脉管间隙浸润对早期宫颈癌预后的影响  

Prognostic impact of lymphovascular space invasion in women with early-stage cervical carcinoma

作　　者：张蓉[1] 李林[1] 雷呈志[1] 吴令英[1] 白萍[1] 李淑敏[1] 

机构地区：[1]中国医学科学院 北京协和医学院肿瘤医院妇瘤科,100021

出　　处：《中华临床医师杂志（电子版）》2013年第16期51-55,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的评价淋巴脉管间隙浸润（LVSI）对早期宫颈癌预后的影响，探讨早期宫颈癌合并LVSI优选治疗方案。方法收集1999年6月至2011年6月经手术治疗的ⅠB～ⅡA期宫颈癌合并LVSI 252例及相对应于年龄、期别、病理类型无差异的无LVSI 253例入组本研究，分析两组间肿瘤大小、间质浸润深度、组织分化、淋巴结转移、术前、术后治疗的差异及其对预后的影响。结果LVSI组的宫颈间质受侵深度〉1／2例数、淋巴结转移率、低分化所占比例、术后接受辅助治疗患者数明显高于无LVSI组，差异具有统计学意义。5年总存活率（OS）LVSI组79．8％，无LVSI组95．7％，5年无瘤存活率（DFS）LVSI组79．8％，无LVSI组94．6％，复发转移、死亡：LVSI组复发39例（15，5％），死亡24例（9．5％），无LVSI组复发13例（5．1％），死亡2例（0．8％），两组间的差异有统计学意义（P=0．000）。全组5年总存活率、无瘤存活率为93．6％、87．7％，单因素分析示临床期别、病理类型、淋巴结转移、脉管间隙浸润影响5年总存活、无瘤存活，肿瘤大小、术后治疗仅影响5年总存活率。多因素分析病理类型、淋巴结转移、脉管间隙浸润是5年总存活、无瘤存活的独立预后因素。结论LVSI与多种不良预后因素相关，早期宫颈癌中病理类型、淋巴结转移、脉管间隙浸润是5年总存活、无瘤存活的独立影响因素。合并LVSI需术后辅助治疗。Objective To evaluate the prognostic value of the presence of lymphovascular space invasion （LVSI） in patients with early-stage cervical carcinoma and discuss the optimized treatment for those patients. Methods 252 cases of patients with LVSI （LVSI group） who underwent radical surgery for stage I B-IIA carcinoma of the cervix from June 1999 to June 2011 at Cancer Hospital, Chinese Academy of Medical Science were retrospectively studied, the control group selected 253 cases of patients, with the familiar ages, stage and pathological type, but without LVSI treated in the corresponding period, whether there were difference between the two group on tumor size, depth of stromal invasion, grade of histological differentiation, metastatic lymph nodes, preoperative and postoperative treatment were analyzed, as well as the influence on prognosis. Results The LVSI group had more cases of deep stromal invasion （〉1/2）, higher lymph node metastasis rate and grade of histological differentiation than the control group, and the number of patients received postoperative adjuvant therapy was significantly higher than those without LVSI. There were statistically significant difference in 5-years overall survival （OS） rates and disease-bee survival （DFS） rates between group LVSI and the control group （P=0.000）, which were 79.8%, 79.8%, 95.7%, 94.6%, respectively. 39 patients （15.5%） developed recurrences and 24 cases （9.5%） dead in the LVSI group, while there were 13 patients （5.1%） relapsed and 2 （0.8%） deaths, the differences were statistically significant （P=0.000）. The 5-years overall survival and disease-free survival rates for the whole group were 93.6%, 87.7%, respectively. Univariate analysis demonstrated that clinical stage, pathological type, metastatic lymph nodes, LVSI were significantly related to the 5-years overall survival and disease-free survival rates, while the tumor size and postoperative treatment only affect the 5-years overall survival rates. Multivariate regress

关 键 词：宫颈肿瘤 预后 淋巴脉管间隙浸润 

分 类 号：R737.33[医药卫生—肿瘤]