早期子宫颈癌术后肺转移的临床病理特征及危险因素分析  

Clinicopathologic characteristics and risk factors for lung metastasis after radical hysterectomy in early-stage cervical cancer

作　　者：郑爱文[1] 陈雅卿[1] 方静[1] 张英丽[1] 

机构地区：[1]浙江省肿瘤医院妇瘤科,杭州310022

出　　处：《中华妇产科杂志》2015年第3期204-209,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨早期（Ⅰ～Ⅱa期）子宫颈癌行根治性手术后发生肺转移的临床病理特征及危险因素。方法收集2008年1月至2013年12月期间浙江省肿瘤医院收治的早期子宫颈癌行根治性手术后发生肺转移的38例患者（肺转移组）的临床病理资料，选择同期连续收治的200例未发生肺转移的早期子宫颈癌患者（无肺转移组）作为对照。观察与早期子宫颈癌术后肺转移相关的临床病理特征；单因素分析（采用χ2检验）两组患者间临床病理特征的差异，多因素分析（采用logistic回归法）早期子宫颈癌患者根治性手术后出现肺转移的独立危险因素。结果（1）与早期子宫颈癌术后肺转移相关的临床病理特征：38例术后发生肺转移患者中，初诊子宫颈癌时的中位年龄为46岁，确诊至术后发生肺转移的中位时间为13个月，50.0%（19/38）的患者于术后第1年发生肺转移。临床分期：根据国际妇产科联盟（FIGO）2009年的分期标准，Ⅰb期19例，Ⅱa期19例；病理类型：鳞癌31例，非鳞癌7例；病理分级：G12例，G227例，G39例；68.4%（26/38）的患者伴随相关血清肿瘤标志物水平上升。临床症状：12例患者出现不同程度的胸部症状，包括咳嗽、咳白色痰、胸闷、咯血丝和胸背痛；肺转移部位：双肺转移25例，右上肺转移5例，右下肺转移3例，左上肺转移3例，左下肺转移2例；肺转移灶大小及个数：肺转移灶最大直径为8～35 mm，单发肺转移灶患者6例，双发肺转移灶患者1例，多发转移灶31例。（2）早期子宫颈癌术后发生肺转移的危险因素分析：对肺转移组和非肺转移组患者的临床病理特征进行单因素分析，结果显示，早期子宫颈癌术后出现肺转移与初诊年龄、临床分期、肿瘤生长方式、病理分级、神经侵犯、腹主动脉旁淋巴结转移无关（P〉0.05）；而与肿瘤直径、病理类型、间质浸Objective To discuss the clinicopathologic characteristics and risk factors for lung metastasis of early-stage cervical cancer after radical hysterectomy. Methods The complete clinicopathologic data of patients with lung metastasis of cervical cancer after radical surgery from January 2008 to December 2013 admitted in Zhejiang Cancer Hospital were retrospectively analyzed by univariate and multivariate analysis. Results （1）There were 38 cases of early cervical cancer suffered from lung metastasis after radical hysterectomy during the period. The median age at diagnosis of cervical cancer was 46 years, the average lung metastasis time was 13 months after operation, 50.0%（19/38） cases occurred in the first year. Thirty-one cases were squamous cell carcinoma and 7 cases were non-squamous cell carcinoma.（2）Univariate analysis showed that age,clinical stage, manner of tumor growth, tumor grade, perineuronal invasion, para-aortic lymph node metastasis were not significant effect on postoperative lung＆nbsp;metastasis（all P〉0.05）. But tumor size, histologic types, depth of stromal invasion, uterine body infiltration, lympho-vascular space invasion,pelvic lymph node metastasis, positive margin and abnormal tumor markers were significantly correlated with postoperative lung metastasis（all P4 cm）, non-squamous cell carcinoma and pelvic lymph node metastasis were more likely to have lung metastasis.

关 键 词：宫颈肿瘤 淋巴转移 肺肿瘤 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]