子宫颈癌根治术中盆腔淋巴结切除数目对患者预后的影响  

The Impact of the Number of Pelvic Lymph Nodes Removed during Radical Resection of Cervical Cancer on Prognosis of Patients

作　　者：南颖 王晓萌 宋玮琦 钟文芳 黎志强[3] 陈春林[3] 毛琛 NAN Ying;WANG Xiaomeng;SONG Weiqi(Department of Epidemiology,School of Public Health,Southern Medical University,Guangzhou Guangdong 510515,China;Department of Nursing,Southern Medical University,Guangzhou Guangdong 510515,China)

机构地区：[1]南方医科大学公共卫生学院流行病学系,广东广州510515 [2]南方医科大学护理学院,广东广州510515 [3]南方医科大学南方医院妇产科,广东广州510515

出　　处：《实用妇产科杂志》2024年第10期816-822,共7页Journal of Practical Obstetrics and Gynecology

基　　金：2021年广东省研究生教育创新计划(编号:D222330012)。

摘　　要：目的:探讨广泛子宫颈癌(CC)根治术中盆腔淋巴结切除(RLN)数目与患者预后的关系。方法:回顾性分析中国CC临床诊疗大数据库中2004年1月1日至2018年8月31日期间行CC根治术患者21416例的临床资料。采用限制性立方样条函数(RCS)分析RLN数目与预后之间的剂量-反应关系,并根据RCS及RLN数目分为1~17枚组(8733例)、18~26枚组(8189例)、≥27枚组(4494例)。采用Kaplan-Meier生存分析和Log-rank对数秩检验比较组间3年、5年总体生存率(OS)和无病生存率(DFS),并通过多因素Cox比例风险回归模型分析预后的死亡风险。结果:①RCS结果示,RLN数目与预后呈“U”型非线性剂量-反应关系(P<0.01):RLN<26枚时,死亡风险随RLN数目的增加而降低,26枚时风险最低;②3组患者的年龄、组织学类型、肿瘤直径、是否有神经浸润、宫体浸润、血管淋巴结间隙浸润、子宫颈浸润、淋巴结转移数目、是否接受术前辅助治疗、术后辅助治疗以及术后辅助治疗是否规范间差异均有统计学意义(P<0.05);③Kaplan-Meier生存分析显示,1~17枚组、18~26枚组、≥27枚组的5年OS依次为90.23%、92.28%、91.61%,5年DFS依次为85.32%、87.90%、87.18%,3组间差异有统计学意义(P<0.01);④多因素Cox回归分析结果示,以18~26枚组为参照组,RLN数目1~17枚为CC患者3年、5年OS及DFS预后的危险因素(HR>1,P<0.05)。结论:RLN范围是影响CC预后的指标之一;当RLN数目为18~26枚时,患者的预后可能更好,RLN数目在1~17枚可能会增加患者的复发或死亡风险。Objective:To investigate the relationship between the number of removed lymph nodes(RLN)and patient prognosis during radical surgery for extensive cervical cancer(CC).Methods:Clinical data of 21416 patients with CC who underwent radical hysterectomy between January 1,2004 to August 31,2018 in the Chinese Cervical Cancer Clinical Study was retrospectively reviewed.Restricted cubic spline(RCS)was used to analyze the dose-response relationship between the number of RLN and prognosis.The patients were divided into three groups according to the RCS and RLN number:1-17 group(8733 cases),18-26 group(8189 cases),and≥27 group(4494 cases).Kaplan-Meier survival analysis and Log-Rank tests were used to compare the OS rates and DFS rates between groups at 3 and 5 years.Multivariate Cox proportional hazards model was used to analyze the prognostic mortality risk.Results:①RCS results showed a U-shaped nonlinear dose-response relationship between the number of RLN and prognosis(P<0.01).When the number of RLN was less than 26,the risk of death decreased as the number of RLN increased,and the risk was lowest when the number of RLN was 26.②There were statistically significant differences(P<0.05)in age,histological type,tumor diameter,nerve invasion,uterine invasion,vaso-lymph node space invasion,cervical invasion,number of lymph node metastasis,whether preoperative adjuvant therapy was received,postoperative adjuvant therapy,and whether postoperative adjuvant therapy was standardized among the 3 groups(P<0.05).③Kaplan-Meier survival curve analysis showed that the 5-year OS of the 1-17 group,18-26 group,and≥27 group were 90.23%,92.28%,and 91.61%,respectively,and the 5-year DFS were 85.32%,87.90%,and 87.18%,respectively.The differences between the three groups were statistically significant(P<0.01).④The results of multivariate Cox regression analysis showed that RLN number in the range of 1-17 was a significant risk factor for the 3-and 5-year OS and DFS,when compared to the 18-26 RLN group(HR>1,P<0.05).Conclusions:RLN nu

关 键 词：子宫颈癌 淋巴结切除数目 预后 真实世界研究 

分 类 号：R713.4[医药卫生—妇产科学]