嗜神经侵袭与宫颈癌临床病理特征的相关性及对预后的影响  

Relationship between perineural invasion and clinical pathological characteristics of cervical cancer and its effects on prognosis

作　　者：张元芬 龙颖[1] 姚德生[1] ZHANG Yuanfen;LONG Ying;YAO Desheng(Department of Gynecological Oncology,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院妇瘤科,南宁530021

出　　处：《中国癌症防治杂志》2025年第1期109-114,共6页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：广西自然科学基金项目(2022GXNFBA035476)。

摘　　要：目的探讨嗜神经侵袭(perineural invasion,PNI)与宫颈癌临床病理特征的相关性及对预后的影响。方法回顾性分析2013年10月至2024年4月在广西医科大学附属肿瘤医院行根治性全子宫切除+盆腔淋巴结清扫术的836例宫颈癌患者的临床资料,分析PNI与宫颈癌临床病理特征之间的关系,并分析PNI对宫颈癌预后的影响。结果836例患者中PNI阳性172例,PNI阳性率为20.6%。单因素分析结果显示,宫颈癌的临床分期、淋巴脉管浸润(lymphvascular space invasion,LVSI)情况、淋巴结转移情况、间质浸润深度、宫旁浸润情况可能与宫颈癌PNI发生有关(均P<0.05);多因素分析发现,宫颈癌的LVSI、淋巴结转移、间质浸润深度>1/2、宫旁浸润及临床分期高均为PNI发生的独立危险因素(均P<0.05)。PNI阳性患者的复发率及死亡率(20.8%vs 9.6%;20.1%vs 11.8%)均高于PNI阴性组,PNI阳性组的5年无进展生存率及5年总生存率(76.4%vs 88.0%;74.2%vs 86.2%)均低于PNI阴性组,差异均有统计学意义(均P<0.05)。结论宫颈癌LVSI、淋巴结转移、间质浸润深度>1/2、宫旁浸润及临床分期高是PNI发生的独立危险因素,但PNI与免疫组化指标(p16和Ki-67)的相关性不大,PNI阳性较PNI阴性宫颈癌患者的预后更差。Objective To investigate the relationship between perineural invasion(PNI)and clinicopathological characteristics,as well as its effects on prognosis of cervical cancer.Methods A total of 836 patients with cervical cancer who underwent radical hysterectomy plus pelvic lymphadenectomy at the Guangxi Medical University Cancer Hospital between October 2013 and April 2024 were retrospec⁃tively analyzed to analyze the relationship between PNI and clinicopathological characteristics of cervical cancer,as well as the factors influencing prognosis.Results Among the 836 patients,172 were PNI positive,the positive rate of PNI was 20.6%.Univariable analysis revealed that clinical stage of cervical cancer,lymph⁃vascular space invasion(LVSI),lymph node metastasis,depth of stromal invasion,and parametrial invasion of cervical cancer might be related to the occurrence of PNI(all P<0.05).Multivariate analysis identified that LVSI,lymph node metastasis,depth of stromal invasion>1/2,parametrial invasion,and high clinical stage were independent risk factors for PNI(all P<0.05).The recurrence and mortality rates in the PNI⁃positive group were higher than those in the PNI⁃negative group(20.8%vs 9.6%;20.1%vs 11.8%).Additionally,the 5⁃year progression⁃free survival rate and 5⁃year overall survival rate in the PNI⁃positive group were lower than those in the PNI⁃negative group(76.4%vs 88.0%,74.2%vs 86.2%),and the differences were statistically significant(all P<0.05).Conclusions LVSI,lymph node metastasis,depth of stromal invasion>1/2,parametrial invasion,and high clinical stage are independent risk factors for the occurrence of PNI.However,no significant correlation is found between PNI and the immunohistochemical indicators(p16 or Ki⁃67).Compared to PNI⁃negative patients,cervical cancer patients with positive PNI have a poorer prognosis.

关 键 词：宫颈癌 嗜神经侵袭 免疫组化 病理特征 预后 

分 类 号：R737.33[医药卫生—肿瘤]