早期子宫颈癌患者术后发生肝转移的危险因素分析  

Analysis of risk factors of postoperative liver metastasis in patients with early cervical cancer

作　　者：丁鑫[1] 王乾印 马亮亮 杨发珍 张忠菲 张元芳 祁元芬 DING Xin;WANG Qianyin;MA Liangliang;YANG Fazhen;ZHANG Zhongfei;ZHANG Yuanfang;QI Yuanfen(Department of Gynecology,Qinghai Red Cross Hospital,Qinghai Prison Administration CenterHospital,Qinghai Xining 810000,China)

机构地区：[1]青海红十字医院青海省监狱管理中心医院妇五科,青海西宁810000

出　　处：《中国妇幼健康研究》2023年第6期95-101,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的探究早期子宫颈癌患者术后发生肝转移的危险因素。方法选择2018年5月至2021年5月青海红十字医院收治的早期子宫颈癌行根治性手术后发生肝转移的46例患者为肝转移组,未发生肝转移的63例患者作为未转移组,多因素Logistic回归分析影响患者术后发生肝转移的因素;构建风险评分模型并评价其预测效能;另选82例患者进行预测模型验证。结果肿瘤直径>4cm、病理类型为小细胞癌、宫旁或切缘阳性、盆腔淋巴结转移、术前血清鳞状细胞癌抗原(SCC-Ag)升高均是导致早期子宫颈癌患者术后发生肝转移的危险因素(OR值介于3.845~5.796之间,P<0.05);这些危险因素纳入风险评分模型,分别赋予35、46、31、39、22分的权重,根据截断值(46分、81分)将患者划分为低、中、高危组,模型的准确性和有效性较高,拟合能力较强[受试者工作特征(ROC)曲线下面积为0.849(95%CI:0.786~0.901,P<0.001),灵敏度为89.74%,特异度为85.32%]。结论临床上对存在上述危险因素的早期子宫颈癌患者应给予密切关注,制定个性化的治疗和护理措施。Objective To explore the risk factors of postoperative liver metastasis in patients with early cervical cancer.Methods From May 2018 to May 2021,46 patients with liver metastasis after radical surgery for early cervical cancer in Qinghai Red Cross Hospital were selected as the liver metastasis group,and 63 patients without liver metastasis were selected as the non-metastasis group.Multivariate Logistic regression analysis was used to analyze the factors influencing the occurrence of liver metastasis after operation.Risk scoring model was built and its prediction efficiency was evaluated.Another 82 patients were selected for validation of the prediction model.Results Tumor diameter>4cm,pathological type of small cell carcinoma,positive periuterine or incisional margin,pelvic lymph node metastasis,and preoperative elevated squamous cell carcinoma antigen(SCC-Ag)were the risk factors for postoperative liver metastasis in patients with early cervical cancer(OR=3.845-5.796,respectively,P<0.05).These risk factors were included in the risk scoring model,with weights of 35,46,31,39 and 22 points,respectively,and patients were divided into the low,the medium and the high risk groups according to the cut-off values(46 and 81 points).The accuracy and validity of the model were high,and the fitting ability was strong[area under the receiver operating characteristic(ROC)curve was 0.849(95%CI:0.786-0.901,P<0.001),with the sensitivity of 89.74%and the specificity of 85.32%J.Conclusion Clinically,early cervical cancer patients with the above risk factors should be closely watched and personalized treatment and nursing measures should be formulated.

关 键 词：子宫颈癌 肝转移 危险因素 风险评分模型 

分 类 号：R173[医药卫生—妇幼卫生保健]