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目的分析宫颈癌患者淋巴结转移的特征及其对预后的影响。方法前瞻性研究手术治疗的宫颈癌患者311例,记录术中切除的淋巴结数量、部位、体积和病理结果,随访5年生存状况。结果 (1)311例患者淋巴结转移率23.8%,闭孔处转移率最高62.2%,主要沿宫旁淋巴结→闭孔→髂内、髂外→髂总→直肠旁→腹主动脉淋巴结引流途径顺次转移,3例为跳跃式转移。(2)在影响预后的多因素分析中,淋巴结转移(RR=3.524,95%CI:2.156-5.763)首先入选Cox回归模型。有、无淋巴结转移者的5年生存率分别为54.5%和86.1%(χ2=33.681,P<0.01)。(3)淋巴结转移个数和转移处数的风险比分别是2.441(95%CI:1.464-4.069)和2.484(95%CI:1.119-5.517),淋巴结转移数目≤3枚、4～10枚和>10枚者5年生存率分别是80.0%、57.6%和22.5%(χ2=14.340,P<0.01)。单处淋巴结转移和多处淋巴结转移者的5年生存率分别是72.0%和43.1%(χ2=5.887,P<0.05)。结论宫颈癌淋巴结转移主要沿淋巴引流途径进行,以闭孔处转移最常见。淋巴结转移状态是影响患者预后的最强因素,转移个数和转移处数越多,预后越差。
Objective To analyze the characteristics of lymph node metastasis and prognosis in patients with cervical cancer. Methods A prospective study of 311 patients with cervical cancer undergoing surgery was performed. The number, location, volume and pathological findings of the resected lymph nodes were recorded. Survival status was followed up for 5 years. Results (1) 311 cases of lymph node metastasis rate of 23.8%, the highest obstruction at the transfer rate of 62.2%, mainly along the parathyroid lymph node → closed obturator → iliac, iliac → iliac total → pararectal → abdominal aortic lymph node drainage pathway Sub-transfer, 3 cases for the jump transfer. (2) In the multivariate analysis of prognosis, lymph node metastasis (RR = 3.524, 95% CI: 2.156-5.763) was first enrolled in the Cox regression model. The 5-year survival rates of those with and without lymph node metastasis were 54.5% and 86.1%, respectively (χ2 = 33.681, P <0.01). (3) The risk ratios of lymph node metastasis and metastasis were 2.441 (95% CI: 1.464-4.069) and 2.484 (95% CI: 1.119-5.517), respectively. The number of lymph node metastasis was less than 3, The 5-year survival rates of> 10 were 80.0%, 57.6% and 22.5% respectively (χ2 = 14.340, P <0.01). The 5-year survival rates of patients with lymph node metastasis and multiple lymph node metastases were 72.0% and 43.1%, respectively (χ2 = 5.887, P <0.05). Conclusion Lymph node metastasis of cervical cancer mainly follows lymphatic drainage route, and the most common metastasis is obstruction. Lymphatic metastasis status is the strongest factor affecting the prognosis of patients, the number of metastases and the more the number of metastases, the worse the prognosis.