中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (6): 439-444.doi: 10.19401/j.cnki.1007-3639.2019.06.007

• 论著 • 上一篇    下一篇

宫颈癌周围神经侵犯与复发高危因素的关联研究

刘 山,房 娟,王黎黎,张映红,杜文杰,朱桃花   

  1. 铜陵市妇幼保健院妇科,安徽 铜陵244000
  • 出版日期:2019-06-30 发布日期:2019-07-12
  • 通信作者: 刘 山 E-mail: liushan3456@qq.com

Association between peripheral nerve invasion and recurrence risk factors in cervical cancer

LIU Shan, FANG Juan, WANG Lili, ZHANG Yinghong, DU Wenjie, ZHU Taohua   

  1. Department of Gynaecology, Tongling Maternal and Children Health Care Hospital, Tongling 244000, Anhui Province, China
  • Published:2019-06-30 Online:2019-07-12
  • Contact: LIU Shan E-mail: liushan3456@qq.com

摘要: 背景与目的:宫颈癌是临床常见的妇科恶性肿瘤。分析宫颈癌周围神经侵犯(peripheral nerve invasion,PNI)与复发高危因素之间的关联性。方法:收集安徽省铜陵市妇幼保健院2010年3月—2018年3月按照国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期为ⅠA2~ⅡA期宫颈癌手术的65例患者的全部临床资料,研究宫颈癌周围神经侵犯与其他临床病理特征的关系以及其对宫颈癌患者预后的影响,并分析宫颈癌周围神经侵犯与复发高危因素的关联。结果:神经侵犯阳性与淋巴结阳性、手术切缘阳性以及脉管侵犯具有相关性,且差异有统计学意义(P<0.05)。神经侵犯阳性与临床分期、分化程度、病理学类型、肿瘤大小、肿瘤浸润深度无相关性,且差异无统计学意义(P>0.05)。通过随访发现,神经侵犯阳性患者的5年无复发生存率明显低于阴性的患者(P<0.05)。神经侵犯阳性组与阴性组的5年生存率差异无统计学意义(P>0.05)。全部的Cox多因素分析结果表明,癌细胞分化程度低、深肌层癌细胞浸润以及盆腔淋巴结转移属于影响复发的主要危险因素(P<0.05),神经侵犯不属于影响宫颈癌术后患者生存的独立预后因素(P>0.05)。结论:宫颈癌周围神经侵犯能够明显降低患者的5年无复发生存率,属于宫颈癌发生转移的其中一种途径,能够作为术后的复发高危因素,对早期宫颈癌术后辅助放化疗有指导意义。

关键词: 宫颈癌, 周围神经侵犯, 复发高危因素

Abstract: Background and purpose: Cervical cancer is a common type of gynecological malignant tumor. This study aimed to analyze the association between peripheral nerve invasion (PNI) and recurrence risk factors in cervical cancer. Methods: This study collected the clinical data of 65 patients with ⅠA2-ⅡA cervical cancer who underwent operation in Tongling Maternal and Children Health Care Hospital from Mar. 2010 to Mar. 2018, in accordance with the International Federation of Gynecology and Obstetrics (FIGO) stage. The relationship between the PNI of cervical cancer and other clinicopathological features and the significance of the prognosis of cervical cancer were studied, and the correlation of the risk factors for invasion and the recurrence of cervical cancer was analyzed. Results: The results showed that PNI positivity was correlated with lymph node positivity, surgical margin positivity and vascular invasion positivity (P<0.05). However, there was no correlation between the PNI positivity and the clinical stage, the degree of differentiation, the pathological type, the size of the tumor and the depth of tumor invasion (P>0.05). The follow-up results showed that the 5-year recurrence-free survival rate of the PNI positive group was significantly lower than that of the negative group (P<0.05). There was no significant difference in the 5-year survival rate between the PNI positive group and the negative group (P>0.05). The results of all COX multivariate analyses showed that low degree of differentiation, infiltration of deep myometrium and metastasis of pelvic lymph nodes were main risk factors (P<0.05), which were not independent prognostic factors for the survival of patients after cervical cancer operation (P>0.05). Conclusion: Cervical cancer nerve invasion can significantly reduce patient’s 5-year recurrence-free survival rate, which belongs to one of the pathways of cervical cancer metastasis. It can be used as a high-risk factor for postoperative recurrence, which can guide adjuvant chemotherapy for early-stage cervical cancer.

Key words: Cervical cancer, Peripheral nerve invasion, High-risk factors for recurrence