早期宫颈癌淋巴结转移规律的临床研究

Clinical study of lymph node metastasis in early cervical cancer

Objective?To study the risk factors and patterns of pelvic lymph node metastasis in early cervical cancer, which provide a basis for selective lymph node dissection and postoperative individualized clinical target volume (CTV) outlining. Methods?The clinical data of 7 472 patients with early-stage (ⅠA1~ⅡA2) cervical cancer who underwent radical cervical cancer surgery admitted to Hunan Cancer Hospital from January 2009 to December 2015 were retrospectively analyzed. Results?The rate of pelvic lymph node metastasis in 7 472 patients was 12.93%, and the rate of closed lymph node metastasis accounted for 66.37%. Closed lymph node metastasis was correlated with lymph node metastasis in other regions of the pelvis (χ2=919.478, P<0.001). Among patients with lymph node metastasis, the metastasis rates of lymph nodes with local, skip, and continuous metastasis were 47.72%, 26.92%, and 25.36%, respectively. The mode of lymph node metastasis in early-stage cervical cancer was highly correlated with the type of pathology, lymph vascular space invasion(LVSI) and depth of cervical muscle infiltration (χ2=13.339, P<0.01; χ2=11.365, P<0.01; χ2=16.616, P<0.001). In addition, χ2 test showed that age, tumor grade, tumor size, clinical stage, pathological type, LVSI, deep myometrial infiltration of the cervix, and intrauterine involvement were independent influencing factors of pelvic lymph node metastasis (P<0.001); logistic regression analysis showed that age, pathological type, LVSI, deep myometrial infiltration of the cervix, intrauterine involvement, and tumor grade were independent factors of pelvic lymph node metastasis (P<0.01). Conclusion?The metastasis pattern and risk factors of early cervical cancer can guide the scope of lymph node dissection and the outline of CTV in postoperative personalized radiotherapy target area.