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作者	单位	E-mail
张惠	南京医科大学附属上海一院临床医学院上海 201600	zhanghui951130@163.com
黄玉恒	上海交通大学医学院附属第一人民医院上海 201600
张黎明	浙江大学医学院附属妇产科医院浙江杭州 310000
周珑	上海交通大学医学院附属第一人民医院上海 201600
孙云燕	南京医科大学附属上海一院临床医学院上海 201600；上海交通大学附属新华医院妇产科上海 200082

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中文摘要:

摘要目的：分析上海市第一人民医院2015年至2019年期间250例分期为IB～IIA期的宫颈癌患者腹主动脉旁淋巴结（para-aortic lymph node，PALN）转移的危险因素，并探讨在早期宫颈癌手术中PALN清扫的意义。方法：回顾性分析250例宫颈癌患者的临床及病理资料，这些患者均接受了腹腔镜或开腹根治性子宫切除术+双侧盆腔淋巴结（pelvic lymph node，PLN）及PALN清扫术，采用统计学方法，通过单因素分析及多因素分析来讨论影响PALN转移的危险因素。结果：在250例宫颈癌患者中，PLN的转移率为27.60 %（69/250），PALN的转移率为6.40 %（16/250），在PLN转移阳性中，有15例PALN转移阳性的患者，转移率为21.74 %（15/69）。单因素分析显示，肿瘤最大直径、分期、淋巴脉管间隙浸润（lymph vascular space invasion，LVSI）、PLN转移以及鳞状上皮细胞癌抗原(SCC-Ag)与PALN转移有关（P＜0.05），而多因素分析显示，分期为IIA期、PLN转移阳性以及PLN转移的个数≥3个是PALN转移的独立危险因素。将这些危险因素代入回归方程以建立临床预测模型，Y=-5.691+1.497×IIA期+3.627×PLN转移（Y代表PALN转移率），利用受试者工作特征（receiver operating characteristic，ROC)曲线评估这些独立危险因素对于判断PALN转移是否具备一定的诊断价值，此时截断值（cut-off value）为0.064，灵敏度为93.80 %，特异度为76.90 %，曲线下面积（AUC）为0.907（P＜0.001，95 % CI：0.859～0.955），H-L检验（Hosmer-Lemeshow）发现该模型拟合优度效果较好（P＞0.05）。同时通过绘制ROC曲线发现，当PLN转移个数≥3个以及肿瘤最大直径≥3.4 cm时，对判断是否存在PALN转移也具有一定的临床价值。结论：通过分析表明IIA期、PLN转移阳性以及转移个数≥3个是PALN转移的独立危险因素，可以对这些因素展开进行充分的评估与诊断，从而更加优化宫颈癌患者的分期、手术方式、治疗方案，为患者提供个体化临床诊疗，以期提高宫颈癌患者的生存质量，减少术后的并发症，改善患者的预后等。

英文摘要:

ABSTRACT Objective: To analyze the risk factors of para-aortic lymph node (PALN) metastasis in 250 cervical cancer patients with stage IB～IIA stage from 2015 to 2019 in Shanghai General Hospital, and to explore the significance of PALN dissection in early cervical cancer surgery. Methods: The clinical and pathological data of 250 patients with cervical cancer who underwent laparoscopic or open radical hysterectomy + bilateral pelvic lymph node (PLN) and PALN dissection were retrospectively analyzed. Analysis and multivariate analysis were performed to discuss the risk factors affecting PALN metastasis. Results: Among 250 patients with cervical cancer, the metastasis rate of PLN was 27.60 % (69/250), and the metastasis rate of PALN was 6.40 % (16/250). Among PLN metastasis-positive patients, there were 15 patients with PALN metastasis-positive, the metastasis rate was 21.74 % (15/69). Univariate analysis showed that the maximum diameter of the tumor, stage, lymph vascular space invasion (LVSI), PLN metastasis, and squamous cell carcinoma antigen (SCC-Ag) were associated with PALN metastasis (P<0.05). Multivariate analysis showed that stage IIA, positive PLN metastasis and the number of PLN metastasis ≥3 were independent risk factors for PALN metastasis. Substitute these risk factors into the established regression equation, Y=-5.691+1.497×IIA stage+3.627×PLN metastasis (Y represents the rate of metastasis), and use the receiver operating characteristic (ROC) curve to evaluate these independent risk factors has certain diagnostic value for judging whether PALN metastasis. At this time, the cut-off value was 0.064, the sensitivity was 93.80 %, the specificity was 76.90 %, and the area under the curve (AUC) was 0.907 (P<0.001, 95 % CI: 0.859-0.955). The H-L test (Hosmer-Lemeshow) found that the quality of fit of the model was good (P>0.05). At the same time, by drawing the ROC curve, it was found that when the number of PLN metastases ≥ 3 and the maximum diameter of the tumor ≥3.4 cm, it also has a certain clinical value for judging whether PALN has metastases. Conclusion: The analysis showed that stage IIA, positive PLN metastasis and the number of metastases ≥3 were independent risk factors for PALN metastasis. These factors can be fully evaluated and diagnosed, so as to optimize the staging, surgical methods, and treatment methods of cervical cancer patients. The treatment plan provides patients with individualized clinical diagnosis and treatment, in order to improve the quality of life of cervical cancer patients, reduce postoperative complications, and improve the prognosis of patients.

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