淋巴结比率对接受手术治疗的89例ⅢC1p期宫颈癌患者的预后价值

杨波; 张庆松; 王蓓蓓; 倪芳芳; 张颖; 韩淑琪

doi:10.16766/j.cnki.issn.1674-4152.003541

淋巴结比率对接受手术治疗的89例ⅢC1p期宫颈癌患者的预后价值

doi: 10.16766/j.cnki.issn.1674-4152.003541

蚌埠医科大学第一附属医院肿瘤妇科，安徽蚌埠 233004

基金项目:

安徽省教育厅高校自然科学研究重点项目 2023AH051982

详细信息

通讯作者:
杨波，E-mail: yangbo@bbmc.edu.cn

中图分类号: R737.33
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-06
- 网络出版日期: 2024-07-22

The prognostic value of lymph node ratio in 89 patients with stage ⅢC1p cervical cancer who underwent surgery

Department of Gynecology and oncology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨淋巴结比率(LNR) 对2018年国际妇产科联盟(FIGO) ⅢC1p期宫颈癌患者的预后影响。方法纳入2014年1月—2017年12月蚌埠医学院第一附属医院妇瘤科收治的89例淋巴结阳性宫颈癌患者，均接受了根治性子宫切除术以及系统性盆腔联合或不联合腹主动脉旁淋巴结切除术。所有患者术后均接受同步放化疗。LNR定义为阳性淋巴结与移除的淋巴结总数的比率。根据LNR将患者分为2组：LNR＜0.06(42例)和LNR≥0.06(47例)。LNR的预后价值通过log-rank检验和多变量Cox回归模型进行评估。结果中位随访时间为44.6个月(范围为6~115个月)，整个队列的5年无病生存(DFS)率为61.6%，5年总生存(OS)率为69.7%。LNR＜0.06和LNR≥0.06的5年DFS率分别为65.4%和54.2%(P=0.027)。此外，LNR＜0.06和LNR≥0.06的5年OS率分别为82.8%和59.6%(P=0.003)。在多变量分析中，LNR≥0.06与较差的DFS(HR=2.040，95% CI：1.130~3.870，P=0.013)和OS(HR=1.940，95% CI：1.020~3.780，P=0.038)有相关性。结论 LNR≥0.06可能是ⅢC1p期宫颈癌患者DFS和OS下降的独立预后因素。
- 子宫颈癌 /
- 淋巴结比率 /
- ⅢC1p期 /
- 预后分析
Abstract: Objective To investigate the prognostic impact of lymph node ratio (LNR) on 2018 International Federation of Gynaecology and Obstetrics Stage ⅢC1p cervical cancer patients. Methods A total of 89 patients with lymph node-positive cervical cancer from January 2014 to December 2017 in the Oncology Department of the First Affiliated Hospital Bengbu Medical University underwent radical hysterectomy and systematic pelvic lymphadenectomy with or without abdominal aortic dissection. All patients received concurrent chemoradiotherapy. LNR was defined as the ratio of positive lymph nodes to the total number of LNS removed. Patients were divided into 2 groups according to LNR; LNR < 0.06(42 cases) and LNR≥0.06 (47 cases). The prognostic value of LNR was assessed by univariate log-rank test and multivariable Cox regression models. Results The median follow-up was 44.6 months (range, 6-115 months), and the 5-year disease-free survival (DFS) rate for the entire cohort was 61.6%, while the 5-year overall survival (OS) rate was 69.7%. The 5-year DFS rates for LNR < 0.06 and LNR≥0.06 were 65.4% and 54.2%, respectively (P=0.027). Furthermore, the 5-year OS rates for LNR < 0.06 and LNR≥0.06 were 82.8% and 59.6%, respectively (P=0.003). In multivariable analysis, LNR≥0.06 was associated with worse DFS (HR=2.040, 95% CI: 1.130-3.870, P=0.013) and OS (HR=1.940, 95% CI: 1.020-3.780, P=0.038). Conclusion LNR≥0.06 may be an independent prognostic factor for decreased DFS and OS in patients with stage ⅢC1P cervical cancer.
- Cervical cancer /
- Lymph node ratio /
- Stage ⅢC1p /
- Prognostic analysis

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图 1 不同LNR水平宫颈癌患者DFS比较

Figure 1. Comparison of DFS in cervical cancer patients with different LNR levels

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图 2 不同LNR水平宫颈癌患者OS比较

Figure 2. Comparison of OS in cervical cancer patients with different LNR levels

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表 1 89例ⅢC1p期宫颈癌患者临床病理特征

Table 1. Clinicopathologic features of 89 cases of cervical cancer with FIGO Stage ⅢC1p in 2018

项目	类别	例数(%)
组织学类型	鳞癌	81(91.0)
	非鳞癌	8(9.0)
淋巴脉管间隙受累	阴性	79(88.8)
	阳性	10(11.2)
浸润程度	＜1/2肌层	15(16.9)
	≥1/2肌层	74(83.1)
肿瘤大小	≤4 cm	58(65.2)
	>4 cm	31(34.8)
淋巴结比率	＜0.06	42(47.2)
	≥0.06	47(52.8)

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表 2 89例ⅢC1p期宫颈癌患者DFS的单因素和多因素分析

Table 2. Univariate and multivariate analysis of DFS in 89 patients with stage Ⅲ C1p cervical cancer

项目	例数	5年DFS[例(%)]	单因素分析P值	多因素分析
项目	例数	5年DFS[例(%)]	单因素分析P值	HR值	95% CI	P值
年龄(岁)			0.680
≥48	49	24(48.9)
＜48	40	21(52.5)
组织学类型			＜0.001	2.230	1.270~3.830	0.018
鳞癌	81	42(51.8)
非鳞癌	8	3(37.5)
浸润程度			0.860
＜1/2肌层	15	8(53.3)
≥1/2肌层	74	37(50.0)
肿瘤大小(cm)			0.010	1.470	0.850~2.790	0.120
≤4.0	58	36(62.1)
>4.0	31	9(29.0)
淋巴脉管间隙受累			0.970
阴性	79	40(50.6)
阳性	10	5(50.0)
淋巴结比率			0.027	2.040	1.130~3.870	0.013
＜0.06	42	29(69.0)
≥0.06	47	16(34.0)

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表 3 89例ⅢC1p期宫颈癌患者OS的单因素和多因素分析

Table 3. Univariate and multivariate analysis of OS in 89 patients with stage Ⅲ C1p cervical cancer

项目	例数	5年OS[例(%)]	单因素分析P值	多因素分析
项目	例数	5年OS[例(%)]	单因素分析P值	HR值	95% CI	P值
年龄(岁)			0.940
≥48	49	16(32.7)
＜48	40	11(27.5)
组织学类型			0.020	1.760	0.890~4.120	0.060
鳞癌	81	24(29.6)
非鳞癌	8	3(37.5)
浸润程度			0.890
＜1/2肌层	15	5(33.3)
≥1/2肌层	74	22(29.7)
肿瘤大小(cm)			0.038	1.620	0.670~3.130	0.240
≤4.0	58	23(39.7)
>4.0	31	4(12.9)
淋巴脉管间隙受累			0.200
阴性	79	22(27.8)
阳性	10	5(50.0)
淋巴结比率			0.003	1.940	1.020~3.780	0.038
＜0.06	42	18(42.9)
≥0.06	47	9(19.1)

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