Ⅰb～Ⅱb期宫颈癌盆腔淋巴结转移相关因素分析与预测  

Analysis of related factors and prediction of pelvic lymph node metastasis in patients in stage Ⅰb to Ⅱb cervical carcinoma

作　　者：李素玉[1] 郑祥钦[1] 宋建榕[1] 林丹枚 张宇龙[1] 张钧 杨丹林[1] Li Suyu;Zheng Xiangqin;Song Jianrong(Fujian Provincial Maternity and Children＇s Hospital, Fuzhou 350001)

机构地区：[1]福建省妇幼保健院,福州350001

出　　处：《现代妇产科进展》2018年第4期263-267,共5页Progress in Obstetrics and Gynecology

基　　金：福建省医学创新课题(No:2015-CXB-9);福建省妇幼保健院科研基金项目(妇保院研15-24)

摘　　要：目的:研究Ⅰb~Ⅱb期宫颈癌盆腔淋巴结转移相关因素,建立风险预测模型,为指导临床实践提供参考。方法:回顾分析福建省妇幼保健院收治的194例Ⅰb~Ⅱb期宫颈癌病例的临床病理资料。Logistic逐步回归法筛选盆腔淋巴结转移相关因素并建立风险预测模型。结果:Ⅰb~Ⅱb期宫颈癌病例中,盆腔淋巴结转移率为21.13%(41/194)。盆腔淋巴结转移率与临床分期、治疗前血清鳞状细胞癌抗原(SCC-Ag)水平、肿瘤直径、脉管癌栓、肌层浸润深度、宫旁浸润、切缘阳性及肿瘤分化显著相关(P均<0.05),这8个因素间存在多重共线性。盆腔淋巴结转移率与宫旁浸润、切缘阳性、肿瘤分化均存在较强关联(OR均>5.0)。Ⅰb~Ⅱb期宫颈癌病例中,宫旁浸润、切缘阳性、肿瘤分化G3者占比较低,分别为4.12%(8/194)、3.61%(7/194)和5.67%(11/194)。经Logistic回归法筛选,最终纳入预测模型的因素为临床分期、肿瘤直径及脉管癌栓,该模型对训练样本预测的正确率为74.5%,模型的拟合优度良好。结论:对于Ⅰb~Ⅱb期宫颈癌病例,临床分期、肿瘤直径及脉管癌栓情况是用于构建预测其盆腔淋巴结转移风险模型的相对最优因素,由此构建的模型具有良好的拟合优度和实用性,可为临床实践提供参考。Objective： To explore the related factors and establish a risk prediction model of pelvic lymph node metastases in patients in stage Ib to IIb cervical carcinoma,and to provide reference for clinical practice. Methods： A retrospective analysis was performed on the clinical and opathologic data of 194 patients in stage Ib to IIb cervical carcinoma confirmed by Fujian Provincial Maternity and Children＇s Hospital. By logistic stepwise regression,the factors related to pelvic lymph node metastasis were filtered and the risk prediction model of pelvic lymph node metastasis was established. Results： Among the patients,the rate of pelvic lymph node metastasis was 21. 13%（ 41/194）. The rate of pelvic lymph node metastasis had significantly correlations with the status of clinical stage,serum level of squamous cell carcinoma antigen before treatment,size of tumor,vascular invasion,depth of tumor invasion,parametrium invasion,surgical margin and tumor differentiation,respectively（ P 0. 05）. Multicollinearity was presented among these factors.The associations were strong with the odds ratios all above 5.0,between the rate of pelvic lymph node metastasis and the status of parametrium invasion,surgical margin and tumor differentiation.Among all patients,the proportions of the patients with positive status of parametrium invasion,positive status of surgical margin and G3 of tumor differentiation,were relatively lower,which were 4. 12%（ 8/194）,3. 61%（ 7/194） and 5. 67%（ 11/194）,respectively.By the logistic regression,three factors that eventually incorporated the predictive model were clinical stage,size of tumor and status of vascular invasion.The model based on these three factors had better goodness of fit with 74.5% accuracy for training samples.Con-clusion： For the patients in stage Ib to IIb cervical carcinoma,the optimal factors used to construct a predictive model for pelvic lymph node metastasis risk were status of clinical stage,size of tumor and vascular invasion.The model based on these

关 键 词：宫颈癌 盆腔淋巴结转移 LOGISTIC回归 预测 

分 类 号：R737.33[医药卫生—肿瘤]