宫颈癌IB1期宫旁转移相关因素分析

【目的】 通过分析宫颈癌IB1期的宫旁转移率以及其相关因素,探讨宫颈癌IB1期宫旁转移的低危因素?【方法】 收集我院2008年1月至2011年2月经手术治疗的149例宫颈癌IB1期病人的临床病理资料,将宫旁浸润与各临床病理指标进行统计学分析,包括单因素χ2检验及多因素Logistic回归分析?【结果】 宫旁转移率为5.4%?单因素分析提示肿瘤大小?淋巴脉管浸润(LSVI)?淋巴结转移?肌层浸润深度?阴道累及?宫体累及情况可能与宫旁转移相关(P值均 < 0.05);多因素分析提示淋巴结转移(HR:26.95,95%CI:2.32 ~ 313.41)与LSVI(HR:47.6,95%CI:2.561 ~ 886.32)是宫旁转移的独立危险因素?LSVI(-)+淋巴结(-)的患者宫旁转移率为0?【结论】 宫颈癌IB1期宫旁转移率较低,淋巴结阴性并且无脉管浸润的患者可考虑实施损伤较小的手术以减少术后并发症,有待大样本随机临床试验进一步证实?

Factors Associated with Parametrial Involvement in Stage IB1 Cervical Cancer

【Objective】 The purpose of our study was to determine possible factors associated with parametrial spread in the patients with stage IB1 cervical cancer and define parameters associated a low risk for parametrial spread, in order to identify candidates for less radical surgery. 【Methods】 We retrospectively reviewed 149 patients with stage IB1 cervical cancer who had undergone primary radical hysterectomy (class III) and pelvic lymphadenectomy in our department from January 2008 to February 2011. All clinical pathological parameters including parametrial involvement were statistically analyzed in SPSS 18.0, with univariate χ2test and multivariate logistic regression model. 【Results】 Overall, 8 (5.4%) of the 149 patients revealed parametrial spread. Tumor size, lymph vascular space invasion (LVSI), positive lymph nodes, depth of invasion, vaginal spread and uterine metastasis were significantly associated with parametrial involvement (P < 0.05). The multivariate analysis model showed positive lymph nodes (HR: 26.95, 95%CI: 2.32-313.41) and LVSI (HR: 47.6, 95% CI: 2.561-886.32) to be the independent predictors of parametrial spread. In patients with no LVSI and negative pelvic nodes, parametrial involvement was found to be 0.0% (0/88). 【Conclusion】Patients with stage IB1 cervical cancer have a relatively lower risk for parametrial spread. Those who without positive lymph nodes or LVSI could be considered for less radical surgery such as modified radical hysterectomy or simple hysterectomy with pelvic lymphadenectomy. Furthermore, postoperative complications including vesical dysfunction and anorectal mobility disorders could be reduced as a result,it will be confirmed by randomized clinical trait of large sample.