单中心559例卵巢癌患者淋巴结转移的危险因素分析与淋巴结切除术临床决策探讨  

Risk factors of lymph node metastasis in 559 patients with ovarian cancer in a single center and clinical decision of lymphadenectomy

作　　者：陈振波 范文生[1] 赵恩锋[1] 李立安[1] 闫志风[1] 叶明侠[1] 杨雯[1] 孟元光[1] CHEN Zhenbo;FAN Wensheng;ZHAO Enfeng;LI Li'an;YAN Zhifeng;YE Mingxia;YANG Wen;MENG Yuanguang(Department of Gynecology and Obstetrics,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心妇产科,100853

出　　处：《中国妇产科临床杂志》2021年第4期360-363,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家重点研发计划课题(2017YFC0110405)。

摘　　要：目的分析盆腔淋巴结转移(pelvic lymph node metastasis, PLNM)和腹主动脉旁淋巴结转移(PALNM)的相关因素并建立预测模型。方法回顾性分析2014年1月至2019年1月解放军总医院第一医学中心妇产科诊治的卵巢癌559例患者的临床病理资料,采用单因素和logistic多因素回归分析影响PLNM和PALNM的危险因素,建立预测模型。结果 559例卵巢癌患者中,盆腔淋巴结转移205例(36.67%),腹主动脉旁淋巴结转移117例(20.93%)。影响PLNM的独立危险因素为双侧病灶(OR=2.278, 95%CI:1.433~3.621)、盆腔转移病灶(OR=1.801, 95%CI:1.154~2.810)、腹腔转移病灶(OR=4.177, 95%CI:2.597~6.717)及阑尾转移(OR=2.332,95%CI:1.389~3.915);影响PALNM的独立危险因素为阑尾转移(OR=2.324, 95%CI:1.383~3.906)和PLNM(OR=7.629, 95%CI:4.615~12.610),年龄≥55岁(OR=0.566, 95%CI:0.350~0.915)为保护因素。PLNM与PALNM概率P的ROC曲线下面积(AUC)分别为0.803(95%CI:0.767~0.840)和0.793(95%CI:0.745~0.841)。结论双侧病灶、盆腔转移病灶、腹腔转移病灶和阑尾转移为影响卵巢癌患者PLNM的独立危险因素;阑尾转移和PLNM为影响PALNM的独立危险因素,≥55岁年龄为保护因素。Objective To review the data of patients with ovarian cancer, analyze the related factors of pelvic lymph node metastasis(PLNM) and para-aortic lymph node metastasis(PALNM), and establish a predictive model, so as to provide suggestions for clinical practice. Methods The clinicopathological data of 559 patients with ovarian cancer treated in Chinese PLA General Hospital from January 2014 to January 2019 were retrospectively analyzed. The risk factors affecting PLNM and PALNM were analyzed by univariate and logistic regression, and the prediction model was established. Results Among 559 ovarian cancer patients, pelvic lymph node metastasis was found in 205 cases(36.67%) and abdominal para-aortic lymph node metastasis in 117 cases(20.93%). The independent risk factors affecting PLNM were bilateral lesions(OR = 2.278, 95%CI : 1.433 ~ 3.621), pelvic metastases(OR = 1.801, 95%CI : 1.154 ~ 2.810), and abdominal metastases(OR = 4.177, 95%CI : 2.597 ~ 6.717) and appendiceal metastasis(OR = 2.332, 95%CI : 1.389 ~ 3.915);The independent risk factors affecting PALNM were appendiceal metastasis(OR = 2.324, 95%CI: 1.383 ~ 3.906) and PLNM(OR = 7.629, 95%CI: 4.615 ~ 12.610). Age( ≥ 55 years)(OR = 0.566, 95%CI: 0.350 ~ 0.915) was the protective factor. The ROC curve AUC of PLNM and PALNM was 0.803(95%CI: 0.767 ~ 0.840) and 0.793(95%CI: 0.745 ~ 0.841), respectively. Conclusion Bilateral lesions, pelvic metastases, intraperitoneal metastases and appendiceal metastases were independent risk factors for PLNM in ovarian cancer patients. Appendiceal metastasis and PLNM were independent risk factors for PALNM, and age( ≥ 55 years) was the protective factor.

关 键 词：卵巢癌 盆腔淋巴结转移 腹主动脉旁淋巴结转移 淋巴结切除术 多因素分析 预测模型 

分 类 号：R737.31[医药卫生—肿瘤]