宫颈癌腹主动脉旁淋巴结转移相关危险因素的研究分析  

Analysis of Risk Factors for Para-aortic Lymph Node Metastasis in Cervical Cancer

作　　者：张惠 黄玉恒 张黎明 周珑 孙云燕 ZHANG Hui;HUANG Yu-heng;ZHANG Li-ming;ZHOU Long;SUN Yun-yan(Department of Obstetrics and Gynecology,Shanghai General Hospital,Nanjing Medical University,Shanghai,201600,China;Department of Obstetrics and Gynecology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,201600,China;Department of Obstetrics and Gynecology,Obstetrics and Gynecology Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang,310000,China;Department of Obstetrics and Gynecology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200082,China)

机构地区：[1]南京医科大学附属上海一院临床医学院,上海201600 [2]上海交通大学医学院附属第一人民医院,上海201600 [3]浙江大学医学院附属妇产科医院,浙江杭州310000 [4]上海交通大学附属新华医院妇产科,上海200082

出　　处：《现代生物医学进展》2022年第18期3447-3453,3468,共8页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81772768)。

摘　　要：目的:分析上海市第一人民医院2015年至2019年期间250例分期为IB~IIA期的宫颈癌患者腹主动脉旁淋巴结(para-aortic lymph node,PALN)转移的危险因素,并探讨在早期宫颈癌手术中PALN清扫的意义。方法:回顾性分析250例宫颈癌患者的临床及病理资料,这些患者均接受了腹腔镜或开腹根治性子宫切除术+双侧盆腔淋巴结(pelvic lymph node,PLN)及PALN清扫术,采用统计学方法,通过单因素分析及多因素分析来讨论影响PALN转移的危险因素。结果:在250例宫颈癌患者中,PLN的转移率为27.60%(69/250),PALN的转移率为6.40%(16/250),在PLN转移阳性中,有15例PALN转移阳性的患者,转移率为21.74%(15/69)。单因素分析显示,肿瘤最大直径、分期、淋巴脉管间隙浸润(lymph vascular space invasion,LVSI)、PLN转移以及鳞状上皮细胞癌抗原(SCC-Ag)与PALN转移有关(P<0.05),而多因素分析显示,分期为IIA期、PLN转移阳性以及PLN转移的个数≥3个是PALN转移的独立危险因素。将这些危险因素代入回归方程以建立临床预测模型,Y=-5.691+1.497×IIA期+3.627×PLN转移(Y代表PALN转移率),利用受试者工作特征(receiver operating characteristic,ROC)曲线评估这些独立危险因素对于判断PALN转移是否具备一定的诊断价值,此时截断值(cut-off value)为0.064,灵敏度为93.80%,特异度为76.90%,曲线下面积(AUC)为0.907(P<0.001,95%CI:0.859~0.955),H-L检验(Hosmer-Lemeshow)发现该模型拟合优度效果较好(P>0.05)。同时通过绘制ROC曲线发现,当PLN转移个数≥3个以及肿瘤最大直径≥3.4 cm时,对判断是否存在PALN转移也具有一定的临床价值。结论:通过分析表明IIA期、PLN转移阳性以及转移个数≥3个是PALN转移的独立危险因素,可以对这些因素展开进行充分的评估与诊断,从而更加优化宫颈癌患者的分期、手术方式、治疗方案,为患者提供个体化临床诊疗,以期提高宫颈癌患者的生存质量,减少术后的并发症,改�Objective:To analyze the risk factors of para-aortic lymph node(PALN)metastasis in 250 cervical cancer patients with stage IB~IIA stage from 2015 to 2019 in Shanghai General Hospital,and to explore the significance of PALN dissection in early cervical cancer surgery.Methods:The clinical and pathological data of 250 patients with cervical cancer who underwent laparoscopic or open radical hysterectomy+bilateral pelvic lymph node(PLN)and PALN dissection were retrospectively analyzed.Analysis and multivariate analysis were performed to discuss the risk factors affecting PALN metastasis.Results:Among 250 patients with cervical cancer,the metastasis rate of PLN was 27.60%(69/250),and the metastasis rate of PALN was 6.40%(16/250).Among PLN metastasis-positive patients,there were 15 patients with PALN metastasis-positive,the metastasis rate was 21.74%(15/69).Univariate analysis showed that the maximum diameter of the tumor,stage,lymph vascular space invasion(LVSI),PLN metastasis,and squamous cell carcinoma antigen(SCC-Ag)were associated with PALN metastasis(P<0.05).Multivariate analysis showed that stage IIA,positive PLN metastasis and the number of PLN metastasis≥3 were independent risk factors for PALN metastasis.Substitute these risk factors into the established regression equation,Y=-5.691+1.497×IIA stage+3.627×PLN metastasis(Y represents the rate of metastasis),and use the receiver operating characteristic(ROC)curve to evaluate these independent risk factors has certain diagnostic value for judging whether PALN metastasis.At this time,the cut-off value was 0.064,the sensitivity was 93.80%,the specificity was 76.90%,and the area under the curve(AUC)was 0.907(P<0.001,95%CI:0.859-0.955).The H-L test(Hosmer-Lemeshow)found that the quality of fit of the model was good(P>0.05).At the same time,by drawing the ROC curve,it was found that when the number of PLN metastases≥3 and the maximum diameter of the tumor≥3.4 cm,it also has a certain clinical value for judging whether PALN has metastases.Conclusion:The analysis

关 键 词：宫颈癌 转移 腹主动脉旁淋巴结 危险因素 

分 类 号：R737.33[医药卫生—肿瘤] R713.42[医药卫生—临床医学]