早期宫颈癌淋巴结转移的高危因素分析及列线图预测模型的构建

目的探讨临床病理特征与早期宫颈癌淋巴结转移的关系,同时建立列线图模型预测只行根治性手术而未进行淋巴结清扫的早期宫颈癌患者淋巴结转移情况。方法回顾性收集福建医科大学附属第一医院妇科432例行子宫切除及淋巴结清扫术并经病理组织学确诊的早期宫颈癌患者术后临床病理资料。运用Logistic回归分析确定早期宫颈癌淋巴结转移的高危因素。建立预测早期宫颈癌淋巴结转移风险的列线图模型,分别用一致性系数(C-index)和校准曲线评估模型的预测性能和符合度。结果 432例早期宫颈癌患者中,有84例患者出现转移,阳性率19.4%。多因素分析显示肿瘤最大径>3 cm、宫旁浸润、淋巴血管间质浸润是早期宫颈癌患者淋巴结转移的独立危险因素,其OR分别为1.98(95%CI:1.17～3.34)、2.64(95%CI:1.28～5.44)、4.77(95%CI:2.60～8.75)。用于预测淋巴结转移风险的列线图的准确度为0.687。结论基于肿瘤最大径>3 cm、宫旁浸润和淋巴血管间质浸润构建的列线图,可用于指导只行根治性手术而未行淋巴结清扫的早期宫颈癌患者的进一步治疗。

Risk Factors of Lymph Node Metastasis in Early-stage Cervical Cancer Patients and Build of A Nomogram Prediction Model

Objective To explore the relationship between clinicopathological characteristics and lymph node metastasis in early-stage cervical cancer patients, and to establish a nomogram model to predict lymph node metastasis in early-stage cervical cancer patients undergoing radical hysterectomy without lymphadenectomy. Methods We retrospectively analyzed clinical pathological data of 432 patients with early-stage cervical cancer undergoing hysterectomy and lymphadenectomy in the First Affiliated Hospital of Fujian Medical University. Logistic regression analysis was used to determine the risk factors for lymph node metastasis of early-stage cervical cancer. A nomogram model for predicting the risk of lymph node metastasis was established, and the predictive performance and compliance of the model were evaluated using the consistency index (C-index) and the calibration curve. Results Among 432 patients with early-stage cervical cancer, 84 patients had lymph node metastasis, with a positive rate of 19.4%. Multivariate analysis showed tumor diameter>3cm, parametrial spread and lymphovascular space invasion were high risk factors for lymph node metastasis of early-stage cervical cancer; OR values were 1.98(95%CI: 1.17-3.34), 2.64(95%CI: 1.28-5.44) and 4.77(95%CI: 2.60-8.75). The accuracy of nomogram used to predict the risk of lymph node metastasis was 0.687. Conclusion A nomogram, constructed based on tumor diameter>3cm, parametrial spread and lymphovascular space invasion, could be used to guide if further treatment is required for early-stage cervical cancer patients who have undergone radical hysterectomy without lymphadenectomy.