191例子宫内膜癌患者淋巴结转移的相关因素分析  

Correlation analysis of lymph node metastasis in 191 cases of endometrial carcinoma in a single center

作　　者：高艳华[1] 郭战坤[1] 魏杏茹 杨平芳 王纪元[1] 曹娟[1] Gao Yanhua;Guo Zhankun;Wei Xingru;Yang Pingfang;Wang Jiyuan;Cao Juan(Department of Gynecology,Baoding Maternal and Child Health Hospital,Baoding 071000,China)

机构地区：[1]河北省保定市妇幼保健院妇科,071000

出　　处：《中国医师杂志》2021年第7期1062-1066,共5页Journal of Chinese Physician

摘　　要：目的通过总结子宫内膜癌(EC)患者病例资料,分析淋巴结转移的相关因素、并建立预测模型,为临床实践提供参考。方法将保定市妇幼保健院妇科2010年1月至2019年12月期间诊治的191例子宫内膜癌患者作为研究对象,采用回顾性研究方法,统计病例相关人口学、手术病理信息,采用单因素和logistie多因素回归分析影响淋巴结转移的危险因素,建立预测模型。结果本研究共纳人191例EC患者,年龄26-76(53.1±9.5)岁,BMI 18.70-40.20(25.84±3.94)kg/m^(2),13例(6.81%)发生淋巴结转移。单因素分析结果显示:EC患者淋巴结转移与肥胖(BMI≥28kg/m^(2))、病理类型(非内膜样腺癌)、分化程度、肌层浸润深度(>1/2)以及脉管浸润相关(P<0.05)。Logistic多因素分析结果显示:低分化(OR=9.475,95%CI:1.840~48.799)、脉管浸润(OR=6.614,95%CI:1.457~30.024)、肌层浸润深度>1/2(OR=4.997,95%CI:1.342~18.600)为EC患者淋巴结转移的独立危险因素(P<0.05)。建立回归方程:Logit P=-4.488+1.609×肌层浸润深度+1.889×脉管浸润+2.249×组织分化程度。EC淋巴结转移概率P的ROC曲线下面积(AUC)为0.813(95%CI:0.688~0.938),截断值取0.56时较理想,此时预测灵敏度为76.9%、特异度为79.2%。结论低分化、脉管浸润、肌层浸润深度>1/2为影响EC患者淋巴结转移的独立危险因素,本研究的logistie回归模型有较好的预测价值。临床医师在临床实践中应综合考虑EC患者病情制定手术方案,避免过度治疗或治疗不足。Objective To summarize the case data of endometrial cancer(EC),analyze the related factors of lymph node metastasis,and establish the prediction model,so as to provide reference for clinical practice.Methods 191 patients with endometrial cancer who were diagnosed and treated in department of gynecology of Baoding Maternal and Child Health Hospital from January 2010 to December 2019 were selected as the research objects.The demographic and surgical pathological information of the patients were analyzed retrospectively.The risk factors of lymph node metastasis were analyzed by univariate and logistic regression analysis,and the predictive model was established.Results A total of 191 patients with EC,aged 26-76(53.1±9.5)years old,body mass index(BMI)18.70-40.20(25.84±3.94)kg/m^(2),13 cases(6.81%)had lymph node metastasis.Univariate analysis showed that lymph node metastasis was associated with obesity(BMI≥28 kg/m^(2)),pathological type(non endometrioid adenocarcinoma),degree of differentiation,depth of myometrial invasion(>1/2)and vascular invasion(P<0.05).Logistic multivariate analysis showed that low differentiation(OR=9.475,95%CI:1.840-48.799),vascular invasion(OR=6.614,95%CI:1.457-30.024)and deep muscle invasion(OR=4.997,95%CI:1.342-18.600)were independent risk factors(P<0.05).The regression equation:Logit P=-4.488+1.609×myometrial infiltration depth+1.889 × vascular infiltration+2.249 × degree of tissue differentiation.The area under the receiver operating characteristic(ROC)curve(AUC)of EC lymph node metastasis probability P was 0.813(95%CI:0.688-0.938).The cut off value of 0.56 was ideal.At this time,the prediction sensitivity was 76.9% and the specificity was 79.2%.Conclusions In clinical practice,gynecologists should consider the condition of EC patients and make operation plan to avoid over treatment or under treatment.

关 键 词：子宫内膜肿瘤 淋巴转移 因素分析 

分 类 号：R737.33[医药卫生—肿瘤]