宫颈癌淋巴结转移的危险因素分析及对预后的影响  

Risk factors analysis of lymph node metastasis of cervical cancer and its impact on prognosis evaluation

作　　者：王芳 吴珍珍[1] 关崇丽 王惠玲[1] 马福堂 赵雅琴 党云[3] 刘青[1] WANG Fang;WU Zhenzhen;GUAN Chongli;WANG Huiling;MA Futang;ZHAO Yaqin;DANG Yun;LIU Qing(Department of Integrated,Traditional Chinese and Western Medicine Gynecology,Gansu Provincial Maternity and Child Care Hospital,Gansu Province,Lanzhou730050,China;Chemotherapy Center,Gansu Provincial Maternity and Child Care Hospital,Gansu Province,Lanzhou730050,China;The Second Department of Gynecology,Gansu Provincial Maternity and Child Care Hospital,Gansu Province,Lanzhou730050,China)

机构地区：[1]甘肃省妇幼保健院中西医结合妇科,甘肃兰州730050 [2]甘肃省妇幼保健院化疗中心,甘肃兰州730050 [3]甘肃省妇幼保健院妇瘤二科,甘肃兰州730050

出　　处：《中国当代医药》2023年第18期82-87,共6页China Modern Medicine

基　　金：甘肃省卫生健康行业科研计划项目(GSWSKY2020-36)。

摘　　要：目的分析宫颈癌淋巴结转移的相关危险因素及其对预后的影响。方法回顾分析自2014年10月至2019年5月甘肃省妇幼保健院收治的484例诊断为宫颈癌ⅠA2~ⅡA2期(FIGO 2009)的患者,均行宫颈癌根治术,通过logistic回归分析淋巴结转移的危险因素,Cox回归以及Kaplan-Meier生存分析淋巴结转移对患者预后的影响。结果484例宫颈癌患者中,病理淋巴结转移者66例,淋巴结转移率为13.64%。单因素分析结果显示,FIGO分期、手术方式、病理类型,以及切缘、宫旁、脉管浸润,宫颈间质浸润、病灶大小,与宫颈癌淋巴结转移有关,差异有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,脉管阳性(β=2.11,OR=8.27,95%CI:3.56~19.18)、宫颈间质浸润外1/3(β=1.38,OR=3.98,95%CI:1.41~11.19)是病理淋巴结转移的独立危险因素(P<0.05)。病理淋巴结转移(β=0.78,OR=2.18,95%CI:1.01~4.70)、腺鳞癌(β=1.18,OR=3.24,95%CI:1.07~10.47)和宫颈间质浸润中1/3(β=0.81,OR=2.25,95%CI:1.04~5.01)是宫颈癌复发的独立危险因素(P<0.05)。病理淋巴结转移组复发风险是非转移组的2.08倍(HR=2.08,95%CI:1.07~4.03),死亡风险是非转移组的11.22倍(HR=11.22,95%CI:1.49~84.49),且病理淋巴结转移数目越多,其复发风险越高。结论脉管和宫颈间质浸润是宫颈癌淋巴结转移的高危因素,淋巴结转移是宫颈癌不良预后的独立危险因素,转移数目越多,预后越差。Objective To analyze the risk factors of lymph node metastasis of cervical cancer and its impact on prognosis.Methods Retrospective analysis of 484 patients diagnosed asⅠA2-ⅡA2 cervical cancer(FIGO 2009)admitted by Gansu Maternal and Child Health Hospital from October 2014 to May 2019.All of them underwent radical cervical cancer surgery.The risk factors of lymph node metastasis and their impact on the prognosis were analyzed by logistic regression,Cox regression and Kaplan-Meier.Results Among 484 cervical cancer patients,66 patients had lymph node metastasis,with a lymph node metastasis rate of 13.64%.The results of univariate analysis showed that the FIGO stage,surgical method,pathological type,incisional margin,periuterine and vascular infiltration,cervical interstitial infiltration,and local lesion size were related to cervical cancer lymph node metastasis,and the differences were statistically significant(P<0.05).Multivariate analysis of logistic regression model showed that vascular positive(β=2.11,OR=8.27,95%CI:3.56-19.18)and cervical infiltration outside 1/3(β=1.38,OR=3.98,95%CI:1.41-11.19)were independent risk factors for pathological lymph node metastasis(P<0.05).Pathological lymph node metastasis(β=0.78,OR=2.18,95%CI:1.01-4.70),adenosquamous cell carcinoma(β=1.18,OR=3.24,95%CI:1.07-10.47)and 1/3 in cervical interstitial infiltration(β=0.81,OR=2.25,95%CI:1.04-5.01)were independent risk factors for cervical cancer recurrence(P<0.05).The recurrence risk of pathological lymph node metastasis group was 2.08 times higher than that of non metastasis group(HR=2.08,95%CI:1.07-4.03),and the risk of death was 11.22 times higher than that of non metastasis group(HR=11.22,5%CI:1.49-84.49).Conclusion Vascular and cervical interstitial infiltration are high risk factors for lymph node metastasis of cervical cancer.Lymph node metastasis is an independent risk factor for poor prognosis of cervical cancer.The more the number of metastasis,the worse the prognosis.

关 键 词：宫颈癌 淋巴结转移 危险因素 预后 

分 类 号：R737[医药卫生—肿瘤]