嗜神经侵袭与早期宫颈癌临床病理特征及预后的关系

目的 探讨嗜神经侵袭（PNI）与早期宫颈癌临床病理特征的关系以及对预后的影响。方法 回顾性分析2010年1月至2014年6月行根治性子宫切除术+盆腔淋巴结清扫术的ⅠA2～ⅡB期300例宫颈癌患者的临床资料，评估早期宫颈癌患者不同临床病理特征与PNI的关系，并分析影响早期宫颈癌患者的预后因素。结果 300例早期宫颈癌患者中，PNI阳性率为15.0％（45／300）。早期宫颈癌PNI的发生与间质浸润、淋巴脉管间隙浸润（LVSI）、淋巴结转移、宫旁浸润有关（P＜0.05），而与临床分期、病理类型、分化程度、肿瘤大小、手术切缘无关（P＞0.05）。在随访期间，PNI阳性组复发率高于PNI阴性组（P＜0.001）；两组死亡率的差异无统计学意义（P＞0.05）。PNI阳性患者的5年无瘤生存率和5年生存率（66.7%，84.4%）均低于PNI 阴性患者（90.1%，93.7%），差异均有统计学意义（P=0.015，P=0.020）。Cox多因素生存分析显示，淋巴结转移、宫旁浸润、手术切缘是影响无瘤生存率和总生存率的独立因素（P＜0.05），间质浸润是影响总生存率的独立因素（P=0.037）；而PNI不是影响无瘤生存率或总生存率的独立因素（P＞0.05）。结论 PNI的发生与早期宫颈癌间质浸润、LVSI、淋巴结转移、宫旁浸润有关，其与预后的关系需要进一步研究。

Clinicopathological and prognostic significance of perineural invasion in early-stage cervical cancer

Objective To evaluate the relationship between perineural invasion (PNI) and clinicopathological characteristics,as well as the prognosis of early-stage cervical cancer.Methods A total of 300 patients with cervical cancer (stages Ⅰ A2-ⅡB) who underwent radical hysterectomy and pelvic lymphadenectomy from Jan 2010 to Jun 2014 were retrospectively analyzed.The relationship of PNI and clinicopathological characteristics,as well as factors influencing prognosis were analyzed.Results Among the 300 patients,the positive rate of PNI was 15.0％ (45/300).PNI had a significant association with depth of invasion,lymphoma vascular space invasion (LVSI),lymph nodes metastases and parametrical invasion (P＜0.05),but not with FIGO stage,pathological type,histological differentiation,tumor size and vaginal margin (P＞0.05).During the follow-up period,the recurrence rate of PNI positive group was higher than that of negative group (P＜0.001);the mortality had no statistical differences between the two groups (P＞0.05).Kaplan-Meier method showed that patients with PNI had shorter 5-year disease-free survival rate and 5-year overall survival rate (66.7％,84.4％) compared with patients without PNI (90.1％,93.7％),and the differences had statistic significance (P =0.015,P=0.020).Cox regression analysis indicated that independent risk factors for disease-free survival rate and overall survival rate included lymph nodes metastases,parametrical invasion and vaginal margin (P＜0.05).Depth of invasion only had impact on overall survival rate (P=0.037).However,PNI was not identified as an independent risk factor for overall survival rate and diseasefree survival rate.Conclusion The incidence of PNI in cervical cancer is closely related with depth of invasion,LVSI,lymph nodes metastases and parametrical invasion.The relationship of PNI and prognosis needs further study.