运用倾向匹配评分分析盆腔淋巴结转移对早期宫颈癌患者生存的影响  

The survival impact of pelvic lymph node metastasis on early cervical cancer patients using propensity score matching analysis

作　　者：黄凤仙[1] 高晖[1] 陈庆芬 曹席明 赵淑红[1] HUANG Fengxian;GAO Hui;CHEN Qingfen;CAO Ximing;ZHAO Shuhong(Department of Radiotherapy,Shaanxi Provincial People's Hospital,Shaanxi Xi'an 710068,China;Department of Gynecology,Northwest University First Hospital,Shaanxi Xi'an 710043,China.)

机构地区：[1]陕西省人民医院放疗科,陕西西安710068 [2]西北大学第一医院妇科,陕西西安710043

出　　处：《现代肿瘤医学》2024年第15期2857-2865,共9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人才支持计划项目(编号:2022JY-24)。

摘　　要：目的:通过使用倾向匹配评分(propensity score matching analysis, PSM)进一步验证和评估盆腔淋巴结转移(pelvic lymph node metastasis, PLNM)对早期宫颈癌患者的生存影响。方法:共纳入2009年01月01日至2016年12月31日间陕西省人民医院宫颈癌根治术后患者533例,其中429例盆腔淋巴结阴性(N0组)、104例盆腔淋巴结阳性(N1组患者)。采用1∶1进行PSM,共104对进入匹配后分析。结果:在PSM前,N0组及N1组在宫颈间质浸润深度(cervical stromal invasion, DSI)、淋巴血管间隙侵犯(lymphovascular space invasion, LVSI)、肿瘤大小及2009 FIGO分期上存在明显差异(P<0.05),经PSM后,匹配后两组在各临床病理特征间均无明显差异(P>0.05)。在PSM前,N0组5年总生存期(overall survival, OS)(85.8%)明显优于N1组(72.1%),经PSM后,匹配后N0组5年OS (83.7%)仍明显优于N1组(72.1%),以上差异均具有统计学意义(P<0.05)。PSM前Cox单因素及多因素分析结果显示:DSI、LVSI、盆腔淋巴结状态及肿瘤大小是宫颈癌患者独立预后影响因素。PSM后Cox单因素及多因素分析结果显示:DSI、LVSI、盆腔淋巴结状态仍是宫颈癌患者独立预后影响因素。结论:无论在PSM前还是在PSM后,盆腔淋巴结转移与早期宫颈癌患者较差的5年OS相关。Objective:To further verify and evaluate the survival impact of pelvic lymph node metastasis(PLNM)on early-stage cervical cancer patients by using propensity score matching analysis(PSM).Methods:A total of 533 patients who underwent radical cervical cancer surgery in Shaanxi Provincial People's Hospital between 2009.01.01 to 2016.12.31 were included,including 429 patients with negative pelvic lymph nodes(N0 group)and 104 patients with positive pelvic lymph nodes(N1 group).Using 1∶1 for PSM,a total of 104 pairs entered the post-matching analysis.Results:Before PSM,there were significant differences in the depth of cervical stromal invasion(DSI),lymphovascular space invasion(LVSI),tumor size and 2009 FIGO stage between the N0 group and the N1 group(P<0.05).After PSM,there was no significant difference between the two groups in the clinical and pathological characteristics(P>0.05).Before PSM,the 5-year overall survival(OS)(85.8%)of the N0 group was significantly better than that of the N1 group(72.1%).After PSM,the 5-year OS(83.7%)of the N0 group was still significantly better than that of N1 group(72.1%)after PSM,the above differences were statistically significant(P<0.05).The results of Cox single-factor and multi-factor analysis before PSM showed that DSI,LVSI,pelvic lymph node status and tumor size were independent prognostic factors in patients with cervical cancer.The results of Cox single-factor and multi-factor analysis after PSM showed that DSI,LVSI,and pelvic lymph node status were still independent prognostic factors in patients with cervical cancer. Conclusion: Pelvic lymph node metastasis is associated with poorer 5-year OS in patients with early-stage cervical cancer,both before and after PSM.

关 键 词：宫颈癌 盆腔淋巴结转移 倾向匹配评分 总生存期 

分 类 号：R737.33[医药卫生—肿瘤]