314例Ⅰb～Ⅱa期宫颈癌预后及淋巴结转移危险因素研究

摘要

目的:回顾性研究探讨早期宫颈癌的临床病理特点、预后影响相关因素及淋巴结转移的高危因素.方法:选择1999年1月至2005年1月在中山大学肿瘤防治中心妇科住院治疗的、经病理确诊的314例早期(Ⅰb～Ⅱa期)宫颈癌临床病例资料进行回顾性分析,分析影响其预后及淋巴结转移的高危因素.结果:314例病例5年生存率为88.0%,复发率为13.4%.单因素分析显示深肌层浸润、脉管内瘤栓、淋巴结转移为总生存时间不良因素(P<0.05).Cox回归分析显示淋巴结转移、深肌层浸润是预后的独立危险因素(P<0.05).盆腔淋巴结转移组数≥3组与盆腔淋巴结转移组数<3组的生存时间有统计学差异(P=0.032).单因素分析示SCCAg、FIGO分期、肿瘤直径、深肌层浸润、脉管内瘤栓、宫旁组织浸润均与盆腔淋巴结转移有关(P<0.05).Logistic回归多因素分析:治疗前SCCAg>3 ng/mL(P<0.001,OR=4.966)、深肌层浸润(P=0.001,OR=5.503)与盆腔淋巴结转移有关.结论:淋巴结转移、深肌层浸润是宫颈癌预后的独立危险因素;治疗前SCCAg>3 ng/mL、深肌层浸润是盆腔淋巴结转移的独立危险因素.%Objective: To explore the clinicopathologic characteristics and prognostic factors of cervical cancer and risk factors of lymph node metastasis. Methods: Clinical data of 314 pathologically confirmed cervical cancer patients in Sun Yat-Sen University Cancer Center from January 1999 to January 2005 were analyzed. Results: The 5-year survival rate of these 314 patients was 88.0 % and the recurrence rate was 13.4 %. In univariate survival analysis, the poor prognostic factors included deep stromal invasion, lymph vascular space involvement, and positive pelvic lymph nodes ( P < 0.05 ), whereas in multivariate survival analysis, the independent prognostic factors included positive pelvic lymph nodes and deep stromal invasion ( P < 0.05 ). Patients with ≥3 pelvic lymph node metastasis had poorer prognosis than patients with < 3 pelvic lymph node metastasis (P = 0.032). Univariate analysis showed that the serum level of squamous cell carcinoma antigen ( SCCAg ) > 3 ng/mL before treatment, clinical stage, tumor size, deep stromal invasion, lymph vascular space involvement, and positive parametrium were associated with pelvic lymph node metastasis (P< 0.05 ). Factors predictive of pelvic lymph node metastasis on logistic forward regression were SCCAg > 3 ng/mL before treatment ( P < 0.001, OR = 4.966 ) and deep stromal invasion (P = 0.001, OR = 5.503 ). Conclusion: Lymph node metastasis and deep stromal invasion are independent risk factors for prognosis in cervical cancer. SCCAg > 3 ng/mL before treatment and deep stromal invasion are independent risk factors for pelvic lymph node metastasis.