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。

Risk Factors for Lymphvascular Space Invasion and Parametrial Infiltration in Early Cervical Cancer-A Retrospective Analysis of 1245 Cases

Objective:To investigate the relationship between lymphvascular space invasion(LVSI) or parametrial infiltration and other clinicopathological factors in early cervical cancer.Methods:We used the clinical and pathological data of 1245 patients with early cervical cancer who underwent surgery in the Department of Gynecology,The First Affiliated Hospital of Xi′an Jiaotong University from January 2009 to January 2019.Patients were classified based on whether they had LVSI or parametrial infiltration.Univariate and multivariate logistic regression analysis were performed to analyze the risk factors of lymphvascular space invasion and parametrial infiltration.Results:The total rate of LVSI in 1245 cases was 14.1%(175/1245),and the total rate of parametrial infiltration was 1.85%(23/1245).Univariate analysis showed that the occurrence of LVSI was statistically not associated with age,FIGO clinical stage,involvement of the vagina,involvement of the lower part of the uterus(P>0.05),but showed statistical differences in type of lesion,pathological type,degree of tumor cell differentiation,depth of cervical invasion,lymph node metastasis,positive margin,parametrial infiltration(P<0.05).According to the stratified analysis of lymph metastasis,LVSI is more likely to occur in patients older than 40 years,with endogenous,squamous lesion,and tumor infiltrating the deep muscular layer of the cervix,even without lymph node metastasis(P<0.05).Parametrial infiltration is statistically related to lesion type,depth of cervical invasion,involvement of vagina,involvement of lower uterine segment,positive margin,lymphatic metastasis and LVSI(P<0.05).Logistic regression analysis showed that LVSI is associated with pathological type,depth of cervical invasion,lymph node metastasis(OR>1,P<0.05);parametrial infiltration is associated with type of lesion,involving the lower part of the uterus,lymph node metastasis related(OR>1,P<0.05).Conclusions:Patients with deep cervical myometrial invasion,lymph node metastasis,and endogenous cervical squamous cell carcinoma are more likely to develop LVSI.And patients with endogenous lesion,tumor infiltrating the deep muscular layer of the cervix,and lymphatic metastasis are more likely to develop parametrial infiltration.Attention should be paid to the extent of parametrial tissue resection for early cervical cancer patients with endogenous lesions,lesions involving the lower uterine segment,lymph node metastasis.