基于中国大陆部分医院宫颈癌诊疗大数据的嗜神经浸润与临床病理参数相关性分析

摘要

Objective To analyze the clinical characteristics and pathological features of patients with perineural invasion by using multi-center data of cervical cancer.Methods The clinical and pathological data of 31 599 patients with cervical cancer were obtained from 34 hospitals in 11 provinces of China from 2004 to 2016.Finally we enrolled 12 931 patients without other treatments before radical hysterectomy in 24 hospitals and retrospectively analyzed the clinical features and their relationship with postoperative pathological factors in patients with PNI.Results The positive rate of PNI in 12 931 cases of cervical cancer was 1.59％ (206/12 931).The positive rate of PNI in patients with stage Ⅱ A cervical cancer was significantly higher than that in patients with stage Ⅰ A-Ⅰ B (x2=122.547,P＜0.01).The positive rate of PNI in endogenous cancer was significantly higher than the other general types of tumor (x2=96.558,P＜0.01).Compared with other pathological types of cervical cancer,PNI was less found in early invasive carcinoma cases (x2=34.071,P＜0.01).The age of PNI-positive group was significantly higher than that of PNI-negative group (t=3.503,P＜0.01).There was no significant difference in terms of histological differentiation,menarche age,number of pregnancies,number of labor,or maximum diameter of tumor between the PNI positive group and the PNI negative group (P＞0.05).The PNI was more likely to be associated with pathological risk factors such as lymph node metastasis,para-uterine metastasis,LVSI,invasive depth and uterine body invasion(P＜0.05).There was no significant difference between the two groups in the risk factors of vaginal resection margin involvement,ovarian metastasis and fallopian tube metastasis (P＞0.05).Multivariate analysis showed that FIGO stage,operative year,cervical invasive depth,LVSI and uterine body invasion were independent risk factors of PNI in cervical cancer(P＜0.05).Conclusion PNI-positive is more likely to occur in endogenous cervical cancer or the cancer with higher FIGO stage,and is less likely to occur in early invasive carcinoma.PNI is more likely to be associated with high risk pathologic factors such as lymph node metastasis,para-uterine metastasis,LVSI,invasive depth and uterine body invasion.FIGO stage,invasive depth greater than 1/2 muscle layer,LVSI,and uterine body invasion are PNI independent risk factors.With the increase of the understanding of PNI,detection rate is gradually increased yearly.%目的 利用中国宫颈癌多中心诊疗大数据,分析宫颈癌嗜神经浸润(PNI)与临床特点、病理特征的相关性.方法 收集国内11省34家医院2004-2016年期间收治的31 599例宫颈癌患者临床数据,最终纳入其中24家医院选择直接行广泛性全子宫切除的12 931例宫颈癌患者的临床及病理资料进行回顾性分析,探讨宫颈癌PNI阳性患者的临床特点以及与术后病理因素的关系.结果 12 931例宫颈癌中PNI阳性率为1.59％(206/12 931).ⅡA期宫颈癌患者出现PNI阳性比例明显比ⅡA期以前宫颈癌患者增加(x2=122.547,P＜0.01);肿瘤大体类型为内生型与其他大体类型相比,出现PNI阳性现象的比例较高(x2=96.558,P＜0.01);早期浸润癌与其他病理组织学类型的宫颈癌相比,较少发现PNI的情况(x2=34.071,P＜0.01);PNI阳性组患者年龄明显高于PNI阴性组患者(t=3.503,P＜0.01).而在组织学分级、初潮年龄、孕次、产次、肿瘤最大径方面,PNI阳性组与PNI阴性组差异无统计学意义(P＞0.05).嗜神经阳性患者与嗜神经阴性患者相比,术后病理更容易合并淋巴结转移、宫旁转移、脉管浸润、宫颈浸润、宫体浸润等病理因素(P＜0.05),而两组在合并阴道切缘阳性、卵巢转移、输卵管转移等病理因素上差异无统计学意义(P＞0.05).多因素分析显示,FIGO分期、手术年份、宫颈浸润深度、脉管浸润、宫体浸润是宫颈癌PNI独立危险因素(P＜0.05).结论 在FIGO分期越高的宫颈癌及内生型宫颈癌中,更容易发生PNI阳性,而在术后病理类型为早期浸润癌中,基本上不发生PNI阳性.PNI更容易合并淋巴结转移阳性,宫旁转移,脉管浸润,宫颈肌层浸润,宫体浸润等危险病理因素.FIGO分期、宫颈浸润大于1/2肌层、脉管浸润、宫体浸润是宫颈癌PNI独立危险因素,而且随着对嗜神经的认识逐年增加,PNI检出率也逐渐增加.