淋巴结转移数目与子宫颈癌患者预后的相关性分析  

Analysis of the Correlation Between the Number of Lymph Node Metastases and Prognosis in Cervical Cancer

作　　者：南颖 王晓萌 钟文芳 宋玮琦 黎志强[3] 任娇娇 陈春林[3] 毛琛[1] NAN Ying;WANG Xiaomeng;ZHONG Wenfang(School of Public Health,Southern Medical University,Guangzhou Guangdong 510515,China;School 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,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》2025年第4期325-330,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析淋巴结转移(LNM)数目与子宫颈癌(CC)患者预后的关系,并从肿瘤学结局的角度探讨将LNM数目纳入国际妇产科联盟(FIGO)2018分期的合理性。方法:选择中国子宫颈癌临床诊疗大数据库中2004年1月1日至2018年8月31日在中国内地地区47家医疗机构接受治疗的63926例CC患者进行回顾性分析,经纳入和排除标准剔除后最终纳入研究对象5462例。根据LNM数目的中位数分为两组:LNM数目<3枚组(n=3417)及LNM数目≥3枚组(n=2045),采用Kap-lan-Meier法并行Log-rank检验比较两组5年总生存率(OS)和无病生存率(DFS)差异,多因素分析使用Cox比例风险回归模型。同时根据LNM数目和分期不同,将FIGO 2018分期中的ⅢC1期分为不同亚组,即ⅢC1(原ⅢC1期+LNM数目<3枚)、ⅢC2(原ⅢC1期+LNM数目≥3枚),比较两个亚组的肿瘤学结局。结果:①LNM数目<3枚组与≥3枚组中,5年OS分别为81.26%和68.57%,5年DFS分别为72.48%和56.66%,两组比较差异均有统计学意义(P<0.001)。多因素分析显示:调整年龄、组织学类型、肿瘤直径、宫旁浸润、神经浸润、宫体浸润、血管淋巴间隙浸润、子宫颈浸润、阴道残端、术前辅助治疗、术后辅助治疗,LNM数目≥3枚患者的死亡风险(HR 1.73,95%CI 1.51~1.98,P<0.001)与复发(或死亡)风险(HR 1.70,95%CI 1.53~1.90,P<0.001)均较LNM数目<3枚患者升高;②本研究重新定义的新FIGO 2018分期中,ⅢC1与ⅢC2的5年OS分别为81.53%和69.30%,5年DFS分别为72.77%和57.58%,两亚组比较差异均有统计学意义(P<0.001)。结论:LNM数目可能是CC患者重要的预后指标之一,同时结合LNM数目的分期系统可以更准确地预测预后。Objective:To analyze the association between the number of lymph node metastases(LNM)on prognosis of patients with cervical cancer(CC),and to explore the rationality of integrating LNM numbers into International Federation of Gynecology and Obstetrics(FIGO)2018 staging system from an oncological outcome perspective.Methods:This retrospective analysis was conducted using data from 63926 patients treated in 47 medical institutions in China' Mainland between January 1,2004 and August 31,2018 within the Clinical Database of Cervical Cancer Treatment in China.After applying the inclusion and exclusion criteria,5462 patients were included in the study.Patients were divided into two groups based on the median number of LNM:the group with LNM<3(n=3417)and the group with LNM≥3(n=2045).Kaplan-Meier survival analysis and Log-rank test were used to compare 5-year overall survival(OS)and 5-year disease free survival(DFS)between the two groups.Meanwhile,Cox proportional risk regression model was used for multivariate analysis.In addition,according to LNM number and stage,and the FIGO 2018 IIIC1 stage was reclassified into different subgroups:IIIC1(FIGO 2018 IIIC1+LNM<3),IIIC2(FIGO 2018 IIIC1+LNM≥3).The tumor outcomes of each subgroup were compared.Results:①The 5-year OS of the LNM<3 group and LNM≥3 group were 81.26%and 68.57%,respectively,and the 5-year DFS were 72.48%and 56.66%,respectively(P<0.001).Multivariate analysis showed that after adjusting for age,histological type,tumor diameter,parametrial invasion,neural invasion,endocervical invasion,lymphovascular space invasion,invasive carcinoma of the cervix,vaginal stump,preoperative adjuvant therapy,and postoperative adjuvant therapy,the risk of death(HR 1.73,95%CI 1.51-1.98,P<0.001)and recurrence(HR 1.70,95%CI 1.53-1.90,P<0.001)in the LNM≥3 group was higher than that in the LNM<3 group.②In the new FIGO 2018 staging system redefined in this study,the 5-year OS of the IIIC1 and IIIC2 subgroups were 81.53%and 69.30%,respectively,and the 5-year DFS were 72.77%and 5

关 键 词：子宫颈癌 淋巴结转移数目 预后 

分 类 号：R737.33[医药卫生—肿瘤]