摘要
目的研究早期宫颈癌盆腔淋巴结转移的危险因素及规律,为其选择性淋巴结切除术和术后个性化放疗临床靶体积(clinical target volume, CTV)的勾画提供依据。方法回顾性分析2009年1月至2015年12月湖南省肿瘤医院收治的7 472例接受宫颈癌根治术的早期(ⅠA1~ⅡA2)宫颈癌患者的临床资料。结果 7 472例患者盆腔淋巴结转移率为12.93%,其中闭孔淋巴结转移率占66.37%。闭孔淋巴结转移与盆腔其他区域淋巴结转移具有相关性(χ^(2)=919.478, P <0.001)。在盆腔淋巴结转移的患者中,淋巴结局部转移、跳跃性转移和连续性转移率分别是47.72%、26.92%和25.36%。早期宫颈癌淋巴结转移方式与病理类型、脉管癌栓及宫颈肌层浸润深度密切相关(χ^(2)=13.339, P <0.01;χ^(2)=11.365, P <0.01;χ^(2)=16.616, P <0.001)。另外,χ^(2)检验显示,年龄、肿瘤分级、肿瘤大小、临床分期、病理类型、脉管癌栓、宫颈深肌层浸润、累及宫体均对淋巴结转移有明显影响(P <0.001);logistic回归分析显示,年龄、病理类型、脉管癌栓、宫颈肌层浸润深度、累及宫体及肿瘤分级是盆腔淋巴结转移的独立影响因素(P <0.01)。结论早期宫颈癌淋巴结的转移规律及危险因素可指导淋巴结切除范围及术后个性化放疗CTV的勾画。
Objective To study the risk factors and patterns of pelvic lymph node metastasis in early cervical cancer,which provide a basis for selective lymph node dissection and postoperative individualized clinical target volume(CTV)outlining. Methods The clinical data of 7 472 patients with early-stage(ⅠA1 ~ Ⅱ A2) cervical cancer who underwent radical cervical cancer surgery admitted to Hunan Cancer Hospital from January 2009 to December 2015 were retrospectively analyzed. Results The rate of pelvic lymph node metastasis in 7 472 patients was 12.93%, and the rate of closed lymph node metastasis accounted for 66.37%. Closed lymph node metastasis was correlated with lymph node metastasis in other regions of the pelvis(χ^(2)= 919.478, P < 0.001). Among patients with lymph node metastasis, the metastasis rates of lymph nodes with local, skip, and continuous metastasis were 47.72%, 26.92%, and 25.36%, respectively. The mode of lymph node metastasis in early-stage cervical cancer was highly correlated with the type of pathology, lymph vascular space invasion(LVSI) and depth of cervical muscle infiltration(χ^(2)= 13.339, P < 0.01;χ^(2)= 11.365, P < 0.01;χ^(2)= 16.616, P < 0.001). In addition, χ^(2)test showed that age, tumor grade, tumor size, clinical stage, pathological type, LVSI, deep myometrial infiltration of the cervix, and intrauterine involvement were independent influencing factors of pelvic lymph node metastasis(P < 0.001);logistic regression analysis showed that age, pathological type, LVSI, deep myometrial infiltration of the cervix, intrauterine involvement, and tumor grade were independent factors of pelvic lymph node metastasis(P < 0.01). Conclusion The metastasis pattern and risk factors of early cervical cancer can guide the scope of lymph node dissection and the outline of CTV in postoperative personalized radiotherapy target area.
作者
陈笑
黄巧丽
夏念
陈亦乐
CHEN Xiao;HUANG Qiaoli;XIA Nian;CHEN Yile(Department of Gynecology,Women’s and Children’s Hospital of Hunan,Changsha 410006,China)
出处
《中国妇产科临床杂志》
CSCD
2021年第6期579-582,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
湖南省自然科学基金联合项目(14JJ7090)。
关键词
宫颈癌
淋巴结转移
盆腔淋巴结切除术
cervical cancer
lymph node metastasis
pelvic lymphadenectomy
