摘要
目的 基于宫颈癌病理特征预测淋巴结转移及死亡风险并建立预测列线图模型。方法 回顾性分析2013年3月—2015年3月在浙江中医药大学附属湖州中医院实施宫颈癌手术的80例患者,根据其结淋巴结转移情况将患者分为淋巴结转移组、非淋巴结转移组,计算淋巴结转移阳性率。建立Logistic回归模型分析影响宫颈癌患者淋巴结转移和预后的独立风险因素;建立预测宫颈癌患者淋巴结转移和死亡风险列线图,并采用一致性系数(C-index)判断模型预测能力。结果 80例宫颈癌患者中,共16例患者出现淋巴结转移,阳性率为20.00%(16/80),转移组临床分期Ⅱb、肿瘤直径>3 cm、宫旁浸润及淋巴结血管浸润发生率分别为50.00%、93.75%、62.50%及62.50%,显著高于非淋巴结转移组(15.63%、42.29%、31.25%及3.11%)(P<0.05)。单因素分析结果显示,临床分期、宫颈糜烂、肿瘤直径、宫旁浸润及淋巴结血管浸润可作为影响宫颈癌患者淋巴结转移的高危因素。多因素分析结果显示,临床分期、宫颈糜烂、肿瘤直径、宫旁浸润及淋巴结血管浸润可独立影响宫颈癌患者淋巴结转移。单因素分析结果显示,临床分期、分化程度、宫旁浸润及淋巴结血管浸润均可作为影响宫颈癌患者预后的高危因素。多因素分析结果显示,临床分期、宫旁浸润及淋巴结血管浸润均可独立影响宫颈癌患者预后。列线图宫颈癌患者淋巴结转移风险的C-index为0.687,列线图预测宫颈癌患者死亡风险的C-index为0.695。结论 基于宫颈癌病理特征建立的列线图,在指导宫颈癌患者预后方面具有重要价值。
Objective to predict the risk of lymph node metastasis and death based on the pathological characteristics of cervical cancer and establish a predictive nomogram model.Methods 80 patients with cervical cancer who underwent hysterectomy and lymphadenectomy in our hospital from March 2013 to March 2015 were retrospectively analyzed.According to their lymph node metastasis, the patients were divided into lymph node metastasis group and non lymph node metastasis group, and the positive rate of lymph node metastasis was calculated.Logistic regression model was established to analyze the independent risk factors of lymph node metastasis and prognosis in patients with cervical cancer;a nomogram was established to predict the risk of lymph node metastasis and death in patients with cervical cancer, and the consistency coefficient(C-index) was used to judge the predictive ability of the model.Results among 80 cases of cervical cancer, 16 cases had lymph node metastasis, the positive rate was 20.00%(16/80).The incidences of clinical stage IIB, tumor diameter > 3 cm, parauterine infiltration and lymph node vascular infiltration in the metastasis group were 50.00%, 93.75%, 62.50% and 62.50% respectively, which were significantly higher than those in the non lymph node metastasis group(15.63%, 42.29%, 31.25% and 3.11%)(P<0.05).Univariate analysis showed that cervical erosion, tumor diameter, parauterine invasion and lymph node vascular invasion could be the risk factors of lymph node metastasis in patients with cervical cancer.Multivariate analysis showed that cervical erosion, tumor diameter, parauterine invasion and lymph node vascular invasion could independently affect lymph node metastasis in patients with cervical cancer.Univariate analysis showed that the degree of differentiation, parauterine invasion and lymph node vascular invasion were the high risk factors affecting the prognosis of patients with cervical cancer.The results of multivariate analysis showed that the prognosis of patients with cervical cancer could be independently affected by parauterine invasion and lymph node vascular invasion.The C-index of lymph node metastasis risk of cervical cancer patients on nomogram was 0.687.The C-index of nomogram was 0.695.Conclusion the nomogram based on the pathological characteristics of cervical cancer has important value in guiding the treatment of cervical cancer patients who only undergo radical hysterectomy but not lymph node resection.
作者
陈燕红
谢芳
余惠霞
管艳兰
CHEN Yan-Hong;XIE Fang;YU Hui-Xia(Department of Gynecology,Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical Universi-ty,Huzhou,Zhejiang 313000,China)
出处
《中国妇幼保健》
CAS
2022年第10期1763-1767,共5页
Maternal and Child Health Care of China
基金
浙江省科技计划项目(2017ZK030)。
关键词
宫颈癌
淋巴结转移
死亡风险
列线图
Cervical cancer
Lymph node metastasis
Risk of death
Nomogram
