早期宫颈腺癌及腺鳞癌临床特征及预后分析

目的:探讨早期宫颈腺癌(AC)及宫颈腺鳞癌(ASC)患者的临床特征及预后相关影响因素。方法:回顾分析2013年1月至2018年3月就诊于郑州大学第一附属医院的早期宫颈腺癌及腺鳞癌(Ia～IIa期)患者213例,其中早期腺癌患者179例,早期腺鳞癌患者34例。比较两种病理类型患者的临床特征,分析患者3年无病生存率(DFS)的影响因素,以及宫颈腺癌和腺鳞癌患者的预后差异。结果:宫颈腺鳞癌患者的肿瘤大小大于宫颈腺癌患者,差异有统计学意义(P0.05);两者的年龄、肿瘤浸润深度和淋巴结转移等临床特征相比,差异均无统计学意义(P0.05)。宫颈腺癌和腺鳞癌患者的3年无病生存率分别为92.1%和69.8%,差异有统计学意义(P0.05)。患者的年龄、肿瘤大小、FIGO分期、辅助治疗、浸润深度及淋巴结转移是影响两种病理类型的预后因素,且肿瘤病理类型、浸润深度和淋巴结转移是影响宫颈腺癌和腺鳞癌预后的独立因素。肿瘤直径大于4cm、FIGO分期IIa期、肿瘤浸润深度大于1/2以及淋巴结转移组中,腺鳞癌患者的3年无病生存率低于腺癌患者,差异均有统计学意义(P0.05)。结论:早期宫颈腺癌和腺鳞癌患者的临床特征大致相似,仅腺鳞癌肿瘤体积大于腺癌。肿瘤大小、临床分期、浸润深度、淋巴转移和辅助治疗均为影响两者预后的因素,肿瘤病理类型、浸润深度和淋巴结转移是影响宫颈腺癌和腺鳞癌患者预后的独立因素。肿瘤直径大于4cm、FIGO分期IIa期、肿瘤浸润深度大于1/2以及淋巴结转移宫颈腺鳞癌患者的预后较差。     

子宫颈腺癌159例预后影响因素分析

目的探讨影响宫颈腺癌预后的高危因素。方法选择1992年1月—2002年12月在中国协和医科大学肿瘤医院初治的159例宫颈腺癌为研究对象,收集其临床病理资料,进行预后影响因素的回顾性分析。结果患者总5年生存率为47 9%。其中临床分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为86 1%、56 4%、36 0%、0。复发或转移发生率为29 6%, 复发或转移患者的5年生存率为17 3%。单因素分析显示,肿瘤直径(P=0 009)、临床分期(P<0 01)、血CA125水平(P=0 039)等与预后有关; 27例手术治疗患者中,淋巴结转移(P=0 001)、深肌层浸润(P=0 009)与预后有关。多因素分析显示,只有临床分期、淋巴结转移是独立的预后影响因素。结论临床分期、淋巴结转移是影响宫颈腺癌预后的主要因素,提高早期检出率、改进治疗措施对于提高宫颈腺癌的生存率有重要意义。     

子宫内膜样腺癌MELF浸润模式的临床病理特征及其预后价值研究

目的:研究子宫内膜样腺癌微囊性、伸长及碎片状(MELF)浸润模式患者的临床病理特征及其在子宫内膜样腺癌患者中的预后价值。方法:回顾性收集179例子宫内膜样腺癌患者的临床及病理资料。由两名高年资且经验丰富的病理医生对所有病例的病理切片进行重新阅片。通过单因素分析研究子宫内膜样腺癌MELF浸润模式的临床病理特征;采用Kaplan-Meier法绘制生存曲线;采用Cox风险比例模型进行预后相关的多因素分析。结果:MELF浸润模式的发生率为15. 6%(28/179)。MELF浸润模式在低级别的子宫内膜样腺癌中发生率较高级别高(19. 3%与2. 6%,P 0. 05)。MELF浸润模式与FIGO分期较高、子宫颈间质受累、淋巴脉管间隙浸润、肌层浸润≥1/2、淋巴结转移有关(P0. 05)。有MELF浸润模式的宫内膜样腺癌患者与无MELF浸润模式的患者相比,总生存率和无复发生存率差异均无统计学意义(P0. 05)。结论:MELF浸润模式与宫内膜样腺癌FIGO分期高、子宫颈间质受累、淋巴脉管间隙浸润、肌层浸润≥1/2、淋巴结转移等不良临床病理因素相关。MELF浸润模式对子宫内膜样腺癌的患者预后影响不大。     

Ⅰ～ⅡA2期宫颈癌淋巴结转移高危因素及对预后的影响

目的探讨宫颈癌盆腔淋巴结转移的高危因素及对预后的影响,提高生存率。方法回顾分析1995年1月至2011年6月在首都医科大学附属北京妇产医院经根治性手术治疗550例Ⅰ~ⅡA2期宫颈癌,盆腔淋巴结转移的相关危险因素及预后。结果 64例宫颈癌有盆腔淋巴结转移,无淋巴结转移者5年生存率92.2%,有转移者5年生存率51.6%(P0.05)。单因素分析,淋巴结转移与临床分期、组织学分级、肿瘤最大径线、宫颈深间质浸润、宫旁浸润、脉管间隙浸润相关(P0.05);宫旁组织浸润、转移淋巴结部位、阴道切缘状况、转移淋巴结数量、转移淋巴结组数,是有盆腔淋巴结转移宫颈癌预后的重要因素(P0.05)。多因素分析宫颈深间质浸润(P=0.001)和脉管间隙浸润(P=0.000)是影响宫颈癌淋巴结转移的独立危险因素;转移淋巴结组数2(P=0.000)是影响有淋巴结转移宫颈癌预后的独立危险因素。结论宫颈深间质浸润、脉管间隙浸润是影响宫颈癌盆腔淋巴结转移的独立高危因素;转移淋巴结组数≥2是有淋巴结转移宫颈癌影响预后的独立危险因素。     

子宫内膜样腺癌MELF浸润模式的研究进展

子宫内膜癌是女性生殖系统常见的恶性肿瘤之一,其最常见的病理形态为子宫内膜样腺癌。早期子宫内膜癌预后较好,但仍有少部分患者预后不良。影响子宫内膜癌预后的不良因素包括肿瘤组织学分级、子宫肌层侵犯深度、淋巴脉管间隙浸润（lymphovascular space invasion,LVSI）、宫颈间质受累及淋巴结转移等。伴微囊性、伸长及碎片状（microcystic,elongated,fragmented,MELF）浸润是子宫内膜样腺癌的一种特殊的浸润子宫肌层的方式。多项研究证实MELF浸润模式与某些影响预后的不良病理因素相关,但是MELF浸润模式的预后意义尚不明确。现就MELF浸润模式的临床病理特征以及预后意义的研究进展进行综述,以期为未来MELF浸润模式的相关研究提供理论参考。     

Ⅰb-Ⅱb期手术治疗的宫颈腺癌卵巢转移及预后分析

目的　探讨Ⅰb—Ⅱb期手术治疗的宫颈腺癌卵巢转移的高危因素 ,并分析预后因素。方法　回顾性研究 32例Ⅰb—Ⅱb期手术治疗的宫颈腺癌的临床病理特点 ,应用 χ2 检验及logistic回归分析探讨 4例卵巢转移的高危因素 ;应用Kaplan -Meier法及Cox回归模型分析预后因素。结果　单因素分析提示卵巢转移的高危因素是临床分期和盆腔淋巴结转移 ,但多因素分析没有发现有统计学意义的危险因素。Cox回归提示肿瘤大小和盆腔淋巴结转移是独立预后因素。结论　对于有高危因素的宫颈腺癌 ,术中保留卵巢需要慎重。     

子宫内膜样腺癌MELF浸润模式的研究进展

子宫内膜癌是女性生殖系统常见的恶性肿瘤之一,其最常见的病理形态为子宫内膜样腺癌。早期子宫内膜癌预后较好,但仍有少部分患者预后不良。影响子宫内膜癌预后的不良因素包括肿瘤组织学分级、子宫肌层侵犯深度、淋巴脉管间隙浸润(lymphovascular space invasion,LVSI)、宫颈间质受累及淋巴结转移等。伴微囊性、伸长及碎片状(microcystic,elongated,fragmented,MELF)浸润是子宫内膜样腺癌的一种特殊的浸润子宫肌层的方式。多项研究证实MELF浸润模式与某些影响预后的不良病理因素相关,但是MELF浸润模式的预后意义尚不明确。现就MELF浸润模式的临床病理特征以及预后意义的研究进展进行综述,以期为未来MELF浸润模式的相关研究提供理论参考。     

Ib—Ⅱb期手术治疗的宫颈腺癌卵巢转移及预后分析

目的：探讨Ib-Ⅱb期手术治疗的宫颈腺癌卵巢转移的高危因素，并分析预后因素。方法：回顾性研究32例Ib-Ⅱb期手术治疗的宫颈腺癌的临床病理特点，应用χ^2检验及logistic回归分析探讨4例卵巢转移的高危因素；应用Kaplan-Meier法及Cox回归模型分析预后因素。结果：单因素分析提示卵巢转移的高危因素是临床分期和盆腔淋巴结转移，但多因素分析没有发现有统计学意义的危险因素。Cox回归提示肿瘤大小和盆腔淋巴结转移是独立预后因素。结论：对于有高危因素的宫颈腺癌，术中保留卵巢需要慎重。     

术前CA199与CA125对早期宫颈腺癌转移及预后预测价值分析

目的探讨术前CA199、CA125与宫颈腺癌患者临床病理的关系及其评估预后的价值。方法回顾性分析四川大学华西第二医院2010年1月至2017年12月收治的177例宫颈腺癌患者的临床病理资料。采用单因素分析术前CA199、CA125与宫颈腺癌患者临床病理特征的关系,ROC曲线分析其对宫颈腺癌转移的预测价值,Kaplain-Meier法分析患者预后。结果单因素分析显示,CA199升高与FIGO分期、深部宫颈间质浸润、组织学类型、肿瘤直径、盆腔淋巴结有无转移、生存状态有相关性;CA125升高与FIGO分期、深部宫颈间质浸润、淋巴脉管浸润、宫旁浸润、组织学类型、组织学分化级别、盆腔淋巴结有无转移、生存状态有相关性;ROC曲线显示CA125对宫旁浸润及淋巴结转移的预测准确率较高,CA199对预后的预测的准确率较高;在ⅠA～ⅡB期宫颈腺癌患者中,CA199、CA125浓度阳性组与阴性组预后有明显差别。结论 CA199、CA125浓度升高与宫颈腺癌高危临床病理特征相关,对判断宫颈腺癌患者预后有一定价值。     

Ⅰ～Ⅲ期子宫内膜癌淋巴结转移及预后的相关因素分析

目的:探讨国际妇产科联盟(FIGO)Ⅰ～Ⅲ期子宫内膜癌患者的临床病理特征与淋巴结转移及预后的相关因素。方法:选择2009～2020年于安徽医科大学第一附属医院妇科因子宫内膜癌行分期手术的患者1346例为研究对象(其中130例淋巴结阳性),对其临床病理特征行单因素及Logistic、Cox多因素回归模型分析与淋巴结转移及生存期预后的相关因素。结果:(1)单因素分析提示:病理类型、组织学分级、肌层浸润深度、肿瘤直径、子宫颈侵犯、淋巴脉管间隙浸润(LVSI)、术前CA_(125)及卵巢受累与淋巴结转移有关(P0.05)。多因素的Logistic回归分析显示:病理类型为非子宫内膜样癌、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/L、卵巢受累是淋巴结转移的独立危险因素(OR1,P0.05)。(2)单因素分析提示:病理类型、组织学分级、肌层浸润深度、子宫颈侵犯、LVSI、淋巴结转移、卵巢受累及术后辅助治疗与总生存期有关(P0.05)。多因素Cox回归验证及Kaplan-Meier生存曲线显示:非子宫内膜样癌、子宫颈侵犯、LVSI阳性和淋巴结转移是影响总生存期的独立危险因素(HR1,P0.05)。结论:特殊病理类型、子宫颈侵犯、LVSI阳性、术前CA_(125)≥35 U/ml及卵巢受累,对淋巴结转移风险具有独立预测意义。特殊病理类型、子宫颈侵犯、LVSI阳性及淋巴结转移是临床预后不良的有力预测因子。进一步完善子宫内膜癌分期手术和术后病理,为指导患者个体化治疗提供有效帮助。     

早期子宫颈癌脉管间隙及宫旁浸润危险因素1245例分析

目的:探讨子宫颈癌淋巴脉管间隙浸润(lymph-vascular space invasion,LVSI)及宫旁浸润与其他临床病理因素的关系。方法:回顾性分析2009年1月至2019年1月期间于西安交通大学第一附属医院妇科接受手术治疗1245例早期子宫颈癌患者的临床资料,分别根据是否LVSI及宫旁浸润分为LVSI组、无LVSI组和宫旁浸润组、无宫旁浸润组,采用单因素和多因素Logistic回归分析脉管及宫旁浸润危险因素。结果:1245例LVSI率14.1%(175/1245),宫旁浸润率1.85%(23/1245)。单因素分析显示LVSI的发生与病灶类型、病理类型、肿瘤细胞分化程度、子宫颈浸润深度、淋巴转移、切缘阳性、宫旁浸润比较,差异有统计学意义(P<0.05)。根据淋巴转移情况分层分析发现,在淋巴未转移组LVSI的发生率与年龄、病灶类型、病理类型、子宫颈浸润深度比较,差异有统计学意义(P均<0.05)。Logistic回归分析显示病灶类型为内生型、病理为鳞癌、子宫颈深肌层浸润和淋巴转移相较于非内生型、非鳞癌、子宫颈浸润浅肌层、无淋巴转移早期子宫颈癌患者是发生LVSI的独立危险因素(OR>1,P<0.05)。单因素分析显示宫旁浸润与病灶类型、子宫颈浸润深度、累及阴道、累及宫体下段、切缘阳性、淋巴转移、LVSI有关(P<0.05)。Logistic回归分析示病灶类型为内生型、累及宫体下段、淋巴转移相较于非内生型、未累及宫体下段、无淋巴转移的早期子宫颈癌患者是发生宫旁浸润的独立危险因素(OR>1,P<0.05)。结论:子宫颈深肌层浸润、淋巴结转移、内生型的子宫颈鳞癌患者更可能发生LVSI;病灶类型为内生型、累及宫体下段、淋巴转移的患者更可能发生宫旁浸润。     

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

BACKGROUND: Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. METHODS: This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. RESULTS: Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. CONCLUSION: Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.     

Optimal surgery and diagnostic approach of stage IA2 squamous cell carcinoma of the cervix

BACKGROUND: Most patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA2 squamous cell carcinoma of the cervix, opt for radical surgery at present. Objective: To review surgical and diagnostic approaches in such patients. STUDY DESIGN: Our patient population consisted of 394 patients with a diagnosis of stage I squamous cell cervical carcinoma (with depth of stromal invasion 10mm or less) according to the 1995 FIGO definition. Biopsy and surgical specimen slides were reassessed retrospectively in all cases. The findings of T2-weighted MR imaging were available from the individual medical charts. RESULTS: None of the patients with stromal invasion of 5mm depth or less showed pelvic lymph node metastasis. However, metastasis to the parametrial connective tissue was found in one case with stage IA1 exhibiting marked lymph-vascular space involvement. There were no deaths due to disease in cases with stromal invasion of 5mm depth or less. The lesions were detected in all 20 cases exhibiting stromal invasion of greater than 5mm in depth. In contrast, the lesions were not detected with T2 imaging in four of six cases (67%) with stage IA2. CONCLUSION: Simple or modified radical hysterectomy with pelvic lymph node dissection may be sufficient for cases of stage IA2 cervical squamous cell carcinoma where lymph-vascular space involvement is absent. T2-weighted MR imaging with no detectable tumor would prove beneficial in the selection of these patients.     

The ability to evaluate prognostic variables on frozen section in hysterectomies performed for endometrial carcinoma

The purpose of this study was to evaluate the ability of the pathologist to assess intraoperatively the hysterectomy specimen in patients with endometrial carcinoma. The past few years have seen the definition of prognostic variables that predict the ultimate outcome of patients with endometrial carcinoma. As a result, the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system to take into account such prognostic factors as grade, depth of myometrial penetration by tumor, cervical involvement, adnexal metastasis, peritoneal cytology, and involvement of pelvic and para-aortic lymph nodes. The need for node evaluation has led to considerable controversy as to whether all hysterectomies for Stage I disease should be performed by gynecologic oncologists. To help predict which patients will need node sampling, several published studies have shown that determination of depth of myometrial penetration can be accomplished by gross evaluation of the uterine specimen, and even more accurately on frozen section. These studies recorded excellent results, but were limited to evaluation by pathologists with specific expertise in gynecologic pathology. The current study evaluated the ability to assess tumor grade, depth of invasion, and presence of cervical invasion by intra-operative evaluation of sixty hysterectomy specimens from patients with clinical Stage I disease. The gross and frozen section reports used for this study were produced by anatomic pathologists ranging in experience level from lecturer to professor, with varying levels of experience in gynecologic pathology. Our results indicate that the level of experience of the pathologist does not affect the ability to accurately assess the specimen for the parameters described. This, in turn, allows the surgeon to correctly determine the need for lymph node sampling in 94% of cases.     

Prognostic significance of DNA topoisomerase II-alpha (Ki-S1) immunoexpression in endometrial carcinoma

OBJECTIVE: In order to determine the significance of proliferative activity (PA) in endometrial carcinomas, we analysed the expression of cell cycle-related antigens in routinely processed tissue. MATERIALS AND METHODS: Serial sections of 113 endometrial carcinoma specimens were immunostained with the monoclonal antibody DNA Topoisomerase II-alpha (Ki-S1). In addition to Topoisomerase II-alpha (Ki-S1) staining, histologic type, International Federation of Gynecology and Obstetrics (FIGO) stage. FIMO grade, depth of myometrial invasion, tumor size, lymphovascular space invasion, serosal and/or adnexal involvement, lymph node metastasis, age and peritoneal cytology were evaluated as prognostic indicators. The median follow-up time was 23 (range, 1 to 126 ) months. RESULTS: FIGO stage, FIGO grade, tumor size, lymphovascular space invasion, lymph node metastasis, peritoneal cytology and Topoisomerase II-alpha (Ki-S1) expression all significantly influenced survival in univariate analyses (p < or = 0.05). In the Cox regression analysis, Topoisomerase II-alpha (Ki-S1), serosal and/or adnexal involvement, and lymph node metastasis expression were the only variables with independent prognostic impact (p < or = 0.05), whereas FIGO stage, FIGO grade, histologic type FIGO grade, depth of invasion, tumor size, lymphovascular space invasion, age and peritoneal cytology had no independent influence (p > 0.05). Topoisomerase II-alpha (Ki-S1) staining was significantly elevated in advanced (Stage II, III, IV) as opposed to early (Stage I) carcinomas (p < or = 0.05). CONCLUSION: The association with established prognosticators for endometrial carcinomas, and the results of uni- and multivariate analysis indicate that the additional evaluation of DNA Topoisomerase II-alpha (Ki-S1) peptide antibody (PA) is useful for classifying patients into subgroups with low and high risk of relapse which might help to individualize the therapeutic strategy in endometrial carcinomas.     

Assessment of the revised International Federation of Gynecology and obstetrics staging for early invasive squamous cervical cancer.

OBJECTIVE: The aim of this study was to investigate the value of the International Federation of Obstetrics and Gynecology (FIGO) classification (1995) for early invasive cervical cancer. Methods. Clinico-pathological analysis was performed in 402 patients with invasive squamous cervical cancer in whom the depth of stromal invasion was 5 mm or less. RESULTS: The incidence of lymph node metastasis was 1.2% (1/82) in patients with 3 mm or less depth of invasion; the node-positive patient was in stage IA1. The incidence of lymph node metastasis was 6.8% (5/73) in patients with 3-5 mm depth of invasion; this increased with increasing horizontal spread from 3.4% for 7 mm or less to 9.1% for more than 7 mm. None of the patients in this series had metastasis to the parametrial tissues. Of 4 patients with recurrence, 3 had horizontal spread of more than 7 mm and the remaining patient was in stage IA2. CONCLUSION: The FIGO definition of early squamous cervical cancer is generally acceptable in its present form.     

局部晚期宫颈癌100例淋巴结转移特点及临床分析

目的：探索局部晚期（ⅠB2/ⅡA2期）宫颈癌的淋巴结转移特点及新辅助化疗对预后及并发症发生率的影响。方法：回顾性分析2008年1月-2016年12月南京医科大学第一附属医院收治的424例ⅠA2～ⅡA2期宫颈鳞癌或腺癌患者的临床资料,随访每位患者的生存情况,比较局部晚期宫颈癌患者淋巴结转移情况及新辅助化疗和直接手术患者在手术并发症及预后方面的差异。结果：共424例宫颈癌患者纳入研究,100例局部晚期宫颈癌患者中有68例直接行根治性手术治疗,32例先行1～2次介入或静脉新辅助化疗后行宫颈癌根治术,术后病理提示盆腔淋巴结转移者20例,没有发现腹主动脉旁淋巴结转移。单因素分析提示深肌层浸润、淋巴脉管间隙浸润（lymph vascular space invasion,LVSI）与淋巴结转移相关（P＜0.05）;组织学类型、分化程度、是否行新辅助化疗与淋巴结转移无关（P＞0.05）。将有统计学意义的单因素进行Logistic回归分析显示,LVSI为淋巴结转移的独立危险因素（P＜0.05）。新辅助化疗组淋巴结转移率为22.2％,手术组则为17.2％,2组比较差异无统计学意义（P＞0.05）。总生存期及无瘤生存期方面,局部晚期宫颈癌明显低于早期者。新辅助化疗组的术后感染发生率较低,手术时间和腹腔引流管留置时间较短,但2组差异无统计学意义（P＞0.05）,而术中输尿管支架置入率、输血率、其他相邻脏器损伤的发生率2组相似。结论：局部晚期宫颈癌预后较早期差,淋巴结转移率明显高于早期,盆腔淋巴结转移主要与LVSI及深肌层浸润有关。新辅助化疗对局部晚期宫颈癌的影响尚不明确,也没有证据证明新辅助化疗影响盆腔淋巴结转移的检出率,在手术相关并发症的发生率方面还需更大样本或多中心的研究。     

早期宫颈癌淋巴结转移高危因素的探讨

目的：统计分析Ⅰa2和Ⅰb1期宫颈癌的临床病理特征,探讨其盆腔淋巴结转移的高危因素。方法：回顾性分析2011年1月—2013年6月期间在天津市中心妇产科医院治疗的117例Ⅰa2、Ⅰb1期宫颈癌患者的临床资料。使用卡方检验及多元Logistic回归方法分析淋巴结转移的高危因素。结果：117例患者中15例（12.8%）发生淋巴结转移,淋巴结未转移者102例（87.2%）。单因素分析结果：肌层浸润深度≥1/2、子宫下段受累、脉管内瘤栓阳性、肿瘤直径＞2 cm、治疗前宫颈鳞状上皮抗原（SCC-Ag）水平为影响Ⅰa2和Ⅰb1期宫颈癌淋巴结转移的因素（均P＜0.05）。多因素分析结果表明,影响淋巴结转移的独立危险因素为治疗前SCC-Ag≥1.5 ng/mL（OR=25.007,95%CI：2.342～250.021,P=0.008）。结论：治疗前SCC-Ag水平是影响Ⅰa2和Ⅰb1期宫颈癌淋巴结转移的高危因素。     

Results of postoperative radiotherapy for clinical stage Ib uterine cervical carcinoma with evidence of microscopic involvement of surgical margin, parametrium and/or lymph node metastasis.

From January 1979 to September 1985, a total of 125 patients preoperatively staged as International Federation of Gynecology and Obstetrics (FIGO) Ib uterine cervical carcinoma were proven to have either microscopic involvement of the surgical margin, parametrium and/or regional lymph node metastasis histopathologically after radical hysterectomy and pelvic lymphadenectomy. All of these patients were treated postoperatively with radiotherapy because of the above indications. Based on indications of postoperative radiotherapy, patients were divided into 3 major subgroups according to the microscopic involvement: group A patients (50) with microscopic evidence of regional lymph node metastasis only; group B patients (59) with microscopic evidence of parametrial involvement; and group C patients (16) with microscopic infiltration of the surgical margin involving the vaginal cuff. All patients were treated with external irradiation using a Cobalt-60 teletherapy machine. The overall actuarial 5-year survival rate was 62% with a 77% 5-year survival rate for group A, a 50% rate for group B and a 75% rate for group C. Further analysis of the prognostic factors revealed that those with regional lymph node involvement of 4 or less had a better chance of survival than those with lymph node involvement of more than 4. Also those with poorly differentiated squamous cell carcinoma had a lower 5-year survival rate than those with moderately or well-differentiated squamous cell carcinoma. Univariate analysis revealed that hemoglobin values, age, and the time interval from surgery to radiotherapy were not significant prognostic factors.