盆腔淋巴结转移数量对可手术宫颈鳞癌患者(Ⅰ_(b1)-Ⅱ_(a2)期)预后的预测价值  

The predictive value of the number of pelvic lymph node metastasis on the prognosis of operable cervical squamous cancer patients(stageⅠ_(b1) to Ⅱ_(a2))

作　　者：黄凤仙[1] 李玢[2] 曹席明 金雯 HUANG Fengxian;LI Bin;CAO Ximing;JIN Wen(Department of Radiotherapy,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China.;Department of Gynecology,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China)

机构地区：[1]陕西省人民医院放疗科,陕西西安710068 [2]陕西省人民医院妇科,陕西西安710068

出　　处：《现代肿瘤医学》2023年第15期2904-2909,共6页Journal of Modern Oncology

基　　金：陕西省重点研发计划项目(编号:2022SF-489);陕西省人民医院科技发展孵化基金项目(编号:2021YJY-43);陕西省人民医院科技人才支持计划项目(编号:2022JY-24)。

摘　　要：目的:验证和评估盆腔淋巴结转移数量(number of pelvic lymph node metastasis,nLNM)在可手术宫颈鳞癌患者(Ⅰ_(b1)-Ⅱ_(a2)期)中的预后预测价值。方法:从我院电子数据库中检索2010年01月01日至2017年12月31日收治的符合纳入和排除标准的可手术宫颈鳞癌(Ⅰ_(b1)-Ⅱ_(a2)期)患者,对最终纳入患者的临床病理特征、治疗方案及预后等信息进行分析。结果:本研究共纳入108例患者,其中nLNM≤2个(N1组)患者共计67例(62.04%),nLNM>2个(N2组)患者共计41例(37.96%)。N1和N2组患者在宫颈间质浸润深度(depth of cervical stromal invasion,DSI)、原发肿瘤大小、2009 FIGO分期等存在明显差异(P<0.05),0x09全组患者的5年总体生存(overall survival,OS)为71.3%,其中淋巴血管间隙侵犯(lymphovascular space invasion,LVSI)阴性和阳性患者的5年OS分别为:82.6%vs 62.9%;宫颈肿瘤浸润深度≤1/2和>1/2患者的5年OS分别为:80.9%vs 63.9%;原始肿瘤大小≤4 cm和>4 cm患者的5年OS分别为:81.3%vs 63.3%;N1与N2组患者的5年OS分别为:80.6%vs 56.1%,以上差异均有统计学意义(P<0.05)。在单因素分析中,LVSI、肿瘤大小、nLNM、2009 FIGO分期为宫颈鳞癌患者5年OS的预后影响因素;进一步的多因素分析结果显示:nLNM仍是宫颈鳞癌患者5年OS的独立预后影响因素,其中调整后的危险比为2.455(95%CI:1.191~5.059)。结论:在可手术宫颈鳞癌患者中,nLNM是一个更好的预后预测指标,可能在宫颈癌FIGO2018分期系统中起着更加重要的作用。Objective:To validate and evaluate the number of pelvic lymph node metastasis(nLNM)for prognostic prediction value in patients with operable cervical squamous cancer(stageⅠ_(b1) to Ⅱ_(a2)).Methods:Patients with operable cervical squamous cancer(Ⅰ_(b1) to Ⅱ_(a2) stage)who fulfilled the inclusion and exclusion criteria were identified from the electronic database of our hospital from January 1,2010 to December 31,2017.Then the information of clinical and pathological characteristics,adjuvant therapies and survival outcomes were reviewed and analyzed.Results:A total of 108 patients were involved in this study,including 67 cases(62.04%)with nLNM≤2(N1 group)and 41 cases(37.96%)with nLNM>2(N2 group).Significant differences were found between N1 and N2 groups in the depth of cervical stromal invasion(DSI),primary tumor size,2009 FIGO stage(P<0.05).The 5-year overall survival(OS)for the entire group was 71.3%.The 5-year OS were 82.6%and 62.9%for the patients with LVSI-negative and LVSI-positive,respectively.The 5-year OS were 80.9%and 63.9%for the patients with DSI≤1/2 and>1/2,respectively.The 5-year OS were 81.3%and 63.3%for the patients with tumor size≤4 cm and>4 cm,respectively.The 5-year OS were 80.6%and 56.1%for the patients with N1 and N2 groups,respectively.All above differences were statistically significant(P<0.05).In univariate analysis,LVSI,tumor size,nLNM and 2009 FIGO stage were prognostic factors for 5-year OS in operable cervical squamous cancer.Multivariate analysis further revealed that nLNM was also the independent prognostic factor for 5-year OS in patients with cervical squamous cancer,and the adjusted hazard ratio was 2.455(95%CI:1.191~5.059).Conclusion:The number of pelvic lymph node metastasis was a better marker for predicting prognosis in patients with operable cervical squamous cancer(stageⅠ_(b1) to Ⅱ_(a2)),which may have an more important role in FIGO 2018 stage system of cervical cancer.

关 键 词：宫颈鳞癌 盆腔淋巴结转移数量 nLNM 预后预测 

分 类 号：R737.33[医药卫生—肿瘤]