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目的:分析ⅠA～ⅡB期宫颈癌盆腔淋巴结转移情况及高危因素,为早期宫颈癌的个体化治疗提供参考。方法:对手术治疗ⅠA～ⅡB期宫颈癌患者的临床资料进行回顾性分析,共142例纳入研究。采用单因素分析比较盆腔淋巴结阳性与阴性患者相关临床病理因素的差异,并对有意义的单因素进行多元Logistic回归分析,探讨早期宫颈癌淋巴结转移的高危因素。结果:142例早期宫颈癌有34例盆腔淋巴结转移阳性,转移率为23.9%(34/142),其中30例(21.1%)闭孔组淋巴结阳性,8例(5.6%)髂内组淋巴结阳性,3例(2.1%)髂外组淋巴结阳性,3例(2.1%)髂总组淋巴结阳性。24例孤立性淋巴结转移,10例多组淋巴结转移。淋巴结转移阳性患者组5年生存率为51.2%,无淋巴结转移组为84.1%,差异具有统计学意义(P<0.05)。单因素分析提示宫颈侵犯类型,肿瘤直径大小,浸润深度,是否有脉管浸润及宫旁浸润与盆腔淋巴结转移相关(P<0.05)。多因素Logistic回归分析提示肿瘤直径超过4 cm,深度浸润,脉管浸润以及宫旁浸润是淋巴结转移的独立危险因素(P<0.05)。结论:ⅠA～ⅡB期宫颈癌盆腔淋巴结转移以闭孔淋巴结最易受累,肿瘤直径超过4 cm,深度浸润,脉管浸润以及宫旁浸润是淋巴结转移的高危因素。
OBJECTIVE: To analyze pelvic lymph node metastases and risk factors of stage ⅠA ~ ⅡB cervical cancer and provide references for individualized treatment of early stage cervical cancer. Methods: The clinical data of patients with stage ⅠA ~ ⅡB cervical cancer were analyzed retrospectively. A total of 142 cases were included in the study. Univariate analysis was used to compare the clinicopathological factors of patients with positive and negative pelvic lymph nodes. Multivariate Logistic regression analysis of significant single factor was used to investigate the risk factors of early cervical cancer with lymph node metastasis. Results: In 142 cases of early cervical cancer, 34 cases of pelvic lymph node metastasis were positive, with a metastasis rate of 23.9% (34/142). Of them, 30 cases (21.1%) had positive lymph node in obturator group and 8 cases (5.6% , 3 cases (2.1%) were positive for external iliac lymph nodes, and 3 cases (2.1%) were positive for common iliac lymph nodes. 24 cases of isolated lymph node metastasis, 10 cases of multiple sets of lymph node metastasis. The 5-year survival rate was 51.2% in patients with positive lymph node metastasis and 84.1% in patients without lymph node metastasis, the difference was statistically significant (P <0.05). Univariate analysis showed that the type of cervical invasion, the size of the tumor, the depth of invasion, the presence of vascular infiltration and parametrial infiltration were associated with pelvic lymph node metastasis (P <0.05). Multivariate logistic regression analysis showed that the tumor diameter was more than 4 cm. Depth infiltration, vascular invasion and uterine infiltration were independent risk factors of lymph node metastasis (P <0.05). CONCLUSION: The pelvic lymph node metastases of stage ⅠA ~ ⅡB are most likely to be affected by obturator lymph nodes. The diameter of tumor is more than 4 cm. The deep infiltration, vascular infiltration and parametrial infiltration are the risk factors of lymph node metastasis.