Analysis of clinical factors correlated with parametrial metastasis in stage IA2-IB1 cervical cancer
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摘要: 目的 探讨IA2-IB1期宫颈癌患者宫旁转移的相关因素。方法 回顾性分析168例行手术治疗的IA2-IB1期宫颈癌患者的临床资料，包括年龄、分期、肿瘤直径、血清鳞状细胞癌抗原(squamous cell carcinoma antigen，SCC)数值，肿瘤组织学类型、肿瘤浸润深度、肿瘤细胞分化程度、盆腔淋巴结转移情况、脉管浸润情况、宫旁转移情况等，对宫旁转移的相关因素进行单因素和多因素分析。结果 168例IA2-IB1期宫颈癌患者中9例发生宫旁转移，宫旁转移率为5.4%。单因素分析显示肿瘤直径>2 cm、血清SCC值显著升高、肿瘤肌层浸润深度>1/2肌层、脉管浸润阳性、盆腔淋巴结转移阳性与宫旁转移密切相关(P < 0.05)，而年龄、临床分期、肿瘤细胞分化程度、肿瘤组织类型与宫旁转移无关。多因素分析显示肿瘤直径>2 cm、脉管浸润、盆腔淋巴结转移是IA2-IB1期宫颈癌宫旁转移的独立危险因素。结论 IA2-IB1期宫颈癌患者宫旁转移率低，肿瘤直径>2 cm、脉管浸润、盆腔淋巴结转移的患者易发生宫旁转移。Abstract: Objective To study the risk factors correlated with parametrial metastasis in patients with stage IA2-IB1 cervical cancer.Methods The clinical pathological characters of 168 surgical cases of stage IA2-IB1 cervical cancer were collected, including age, stage, tumor diameter, serum SCC level, histological classification, depth of invasion, degree of differentiation, pelvic lymph node metastasis, lymph vascular invasion, parametrial metastasis and other clinical information. Univariate and multivariate analysis were performed on the risk factors correlated with parametrial metastasis.Results Parametrial metastasis occurred in 9 cases among 168 cases of stage IA2-IB1 cervical cancer (5.4%). Univariate analysis revealed that tumor diameter>2 cm, high SCC level in serum, depth of invasion >1/2 muscular layer, positive lymph vascular invasion, and pelvic lymph node metastasis were correlated with parametrial metastasis (P < 0.05), while age, pathological stage, degree of differentiation and histological classification had no correlation with parametrial metastasis. Multivariate analysis demonstrated that tumor diameter>2 cm, positive lymph vascular invasion, and pelvic lymph node metastasis were independent risk factors of parametrial metastasis.Conclusion The risk of parametrial metastasis is low in stage IA2-IB1 cervical cancer. The independent risk factors of parametrial metastasis include tumor diameter>2 cm, lymph vascular invasion, and pelvic lymph node metastasis.
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Keywords:
- cervical cancer at early stage /
- parametrial metastasi /
- risk factors
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表 1 临床及病理资料与宫旁转移单因素分析
Table 1. Univariate analysis of clinicopathological data and parametrial metastasis
指标 宫旁转移阳性(n) 宫旁转移阴性(n) χ2/t P 年龄(岁) 0.408 0.524 ≤45 4 54 ＞45 5 105 临床分期 0.926 0.335 ⅠA2 0 4 ⅠB1 9 155 肿瘤直径(cm) 2.733 0.002 ≤2 1 142 ＞2 8 17 血清SCC值(ng/mL) 5.69±8.97 2.03±4.18 2.896 0.049 细胞分化程度 2.498 0.289 G1 1 8 G2 7 108 G3 1 43 组织学类型 1.127 0.584 鳞癌 17 115 腺癌 1 27 腺鳞癌 1 7 肌层浸润深度 12.964 0.001 ≤1/2 2 114 ＞1/2 7 45 脉管浸润 11.875 0.000 阳性 6 26 阴性 3 133 盆腔淋巴结转移 28.125 0.000 是 6 13 否 3 146 
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表 2 宫旁转移多因素logistic回归分析
Table 2. Multivariate logistic regression analysis of parametrial metastasis
因素 OR P 95 %CI 血清SCC值 1.121 0.749 0.451-3.102 肿瘤直径 1.015 0.001 2.349-15.784 肌层浸润深度 6.756 0.920 0.716-1.474 脉管浸润 3.775 0.003 1.571-9.231 盆腔淋巴结转移 7.482 0.000 4.018-19.227
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[1] Gaffney DK, Hashibe M, Kepka D, et al. Too many women are dying from cervix cancer[J]. Obstet Gynecol Surv, 2019, 74(3):154-156. DOI:10.1097/ogx.0000000000000653.
[2] 李文慧, 吴鸣, 谭先杰.开腹与腹腔镜广泛子宫切除术对宫颈癌患者生活质量的影响[J].中国实用妇科与产科杂志, 2019, 35(7):793-796. DOI:10.19538/j.fk2019070118.
[3] Tseng JH, Aloisi A, Sonoda Y, et al. Less versus more radical surgery in stage IB1 cervical cancer:a population-based study of long-term survival[J]. Gynecol Oncol, 2018, 150(1):44-49. DOI:10.1016/j.ygyno.2018.04.571.
[4] Ntzeros K, Thomakos N, Papapanagiotou I, et al. The potential of less radical surgery without parametrectomy. Are we safe?[J]. J Exp Ther Oncol, 2018, 12(4):261-266.
[5] MacDonald MC, Tidy JA. Can we be less radical with surgery for early cervical cancer?[J]. Curr Oncol Rep, 2016, 18(3):16. DOI:10.1007/s11912-016-0501-5.
[6] Oncology FCOG. Figo staging for carcinoma of the vulva, cervix, and corpus uteri[J]. Int J Gynecol Obstet, 2014, 125(2):97-98. DOI:10.1016/j.ijgo.2014.02.003.
[7] 刘继红, 万挺.子宫颈癌手术何去何从[J].中国妇产科临床杂志, 2019, 20(2):102-103. DOI:10.13390/j.issn.1672-1861.2019.02.004.
[8] Haney NM, Alzweri LM, Hellstrom WJG. Male orgasmic dysfunction post-radical pelvic surgery[J]. Sex Med Rev, 2018, 6(3):429-437. DOI:10.1016/j.sxmr.2017.12.003.
[9] Vanichtantikul A, Tantbirojn P, Manchana T. Parametrial involvement in women with low-risk, early-stage cervical cancer[J]. Eur J Cancer Care, 2017, 26(5):e12583. DOI:10.1111/ecc.12583.
[10] Chen L, Zhang WN, Zhang SM, et al. Class I hysterectomy in stage Ia2-Ib1 cervical cancer[J]. Wiitm, 2018, 13(4):494-500. DOI:10.5114/wiitm.2018.76832.
[11] Frumovitz M, Sun CC, Schmeler KM, et al. Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer[J]. Obstet Gynecol, 2009, 114(1):93-99. DOI:10.1097/aog.0b013e3181ab474d.
[12] 詹银珠, 刘峰, 刘育飞, 等.临床早期宫颈癌宫旁转移相关因素分析[J].中华肿瘤防治杂志, 2018, 25(14):1019-1022. DOI:10.16073/j.cnki.cjcpt.2018.14.008.
[13] Kilic C, Cakir C, Yuksel D, et al. Which factors predict parametrial involvement in early stage cervical cancer? a Turkish multicenter study[J]. Eur J Obstet Gynecol Reproductive Biol, 2019, 243:63-66. DOI:10.1016/j.ejogrb.2019.10.033.
[14] Smith B, McCann GA, Phillips G, et al. Less radical surgery for early-stage cervical cancer:can conization specimens help identify patients at low risk for parametrial involvement?[J]. Gynecol Oncol, 2017, 144(2):290-293. DOI:10.1016/j.ygyno.2016.11.029.
[15] Jiamset I, Hanprasertpong J. Risk factors for parametrial involvement in early-stage cervical cancer and identification of patients suitable for less radical surgery[J]. Oncol Res Treat, 2016, 39(7-8):432-438. DOI:10.1159/000447335.
[16] Nanthamongkolkul K, Hanprasertpong J. Predictive factors of pelvic lymph node metastasis in early-stage cervical cancer[J]. Oncol Res Treat, 2018, 41(4):194-198. DOI:10.1159/000485840.
[17] Derks M, van der Velden J, de Kroon CD, et al. Surgical treatment of early-stage cervical cancer:a multi-institution experience in 2124 cases in the Netherlands over a 30-year period[J]. Int J Gynecol Cancer, 2018, 28(4):757-763. DOI:10.1097/igc.0000000000001228.
[18] Ma CC, Zhang Y, Li R, et al. Risk of parametrial invasion in women with early stage cervical cancer:a meta-analysis[J]. Arch Gynecol Obstet, 2018, 297(3):573-580. DOI:10.1007/s00404-017-4597-0.
[19] Yu F, Chen Y, Huang L, et al. Risk factors of node metastasis in cervical carcinoma[J]. Eur J Gynaecol Oncol, 2016, 37(5):662-665. http://d.old.wanfangdata.com.cn/Periodical/zgzllc201911005
[20] Matsuo K, Shimada M, Nakamura K, et al. Predictors for pathological parametrial invasion in clinical stage ⅡB cervical cancer[J]. Eur J Surg Oncol, 2019, 45(8):1417-1424. DOI:10.1016/j.ejso.2019.02.019.
