【作者】 王敏；

【导师】 许飞雪；

【作者基本信息】 兰州大学 ， 临床医学·妇产科学（专业学位）， 2024， 硕士

【摘要】 研究目的:观察神经侵犯在宫颈癌中的阳性率,分析神经侵犯与宫颈癌临床病理特征之间的关系以及对预后的影响,以期为宫颈癌的治疗提供参考。研究方法:纳入2018年1月1日至2022年11月31日在兰州大学第一医院行手术治疗的215例宫颈癌患者,术前2018年国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期为ⅠA2-ⅡA2 期。收集患者的临床病理资料并进行电话随访或门诊随访,记录患者的复发日期或死亡日期,随访截止日期为2024年5月31日。将215例宫颈癌患者根据有无神经侵犯分为阳性组和阴性组,比较两组在高血压、糖尿病、高脂血症、FIGO分期、组织学类型、组织分化程度、宫旁侵犯、淋巴脉管浸润、宫颈间质浸润深度、子宫下段侵犯、淋巴结转移和手术切缘阳性方面的差异。将有统计学差异的因素进行二元Logistic回归分析,筛选神经侵犯发生的独立危险因素。使用Kaplan-Meier法计算生存率并绘制两组的生存曲线,采用Log-rank检验比较组间差异。采用COX回归模型进行单因素和多因素分析,分析神经侵犯是否为影响宫颈癌无进展生存期(Disease Free Survival,DFS)和总生存期(Overall Survival,OS)的独立危险因素。研究结果:1.本研究共纳入215例宫颈癌患者,其中神经侵犯阳性者30例,阳性率为13.95%,神经侵犯阴性者185例,阴性率为86.05%。2.影响宫颈癌神经侵犯发生的单因素分析显示:FIGO分期、高血压、组织分化程度、宫旁侵犯、淋巴结转移和淋巴脉管浸润与神经侵犯的发生显著相关(P<0.05),而糖尿病、高脂血症、组织学类型、宫颈间质浸润深度、手术切缘阳性和子宫下段侵犯在两组间的差异无统计学意义(P>0.05)。多因素分析显示:FIGO 分期(OR=3.464,95%CI:1.365-7.894,P=0.009)、淋巴脉管浸润(OR=3.027,95%CI:1.158-7.914,P=0.024)和组织分化程度(OR=2.924,95%CI:1.088-7.862,P=0.033)是神经侵犯发生的独立危险因素。3.生存分析显示:神经侵犯阳性组的OS和DFS均较神经侵犯阴性组差,差异具有统计学意义(P<0.05)。4.影响宫颈癌DFS的COX单因素分析显示:年龄、FIGO分期、宫颈间质浸润深度、淋巴结转移、淋巴脉管浸润、神经侵犯、子宫下段侵犯和宫旁侵犯是与宫颈癌患者DFS相关的影响因素(P<0.05)。COX多因素分析显示:年龄(H R=1.079,95%CI:1.024-1.137,P=0.004)、宫颈间质浸润深度(HR=3.736,95%CI:1.274-10.959,P=0.016)和淋巴结转移(HR=4.543,95%CI:1.536-13.432,P＝0.006)是影响宫颈癌DFS的独立危险因素。5.影响宫颈癌OS的COX单因素分析显示:年龄、FIGO分期、宫颈间质浸润深度、淋巴脉管浸润、神经侵犯和淋巴结转移是与宫颈癌OS相关的影响因素(P<0.05),COX 多因素分析显示:年龄(HR=1.111,95%CI:1.045-1.180,P=0.001)、宫颈间质浸润深度(HR=5.279,95%CI:1.650-16.890,P=0.005)和淋巴结转移(HR=5.560,95%CI:1.603-19.284,P=0.007)是影响宫颈癌患者O S的独立危险因素。结论:1.神经侵犯在宫颈癌中的阳性率为13.95%,神经侵犯的发生与高血压、组织分化程度、FIGO分期、宫旁侵犯、淋巴脉管浸润和淋巴结转移显著相关,且FIGO分期较晚、组织分化程度低和淋巴脉管浸润阳性是宫颈癌神经侵犯发生的独立危险因素。当出现上述危险因素时,应警惕神经侵犯的存在。2.神经侵犯阳性组的DFS和OS均明显较神经侵犯阴性组短,神经侵犯是影响宫颈癌预后重要因素之一。3.影响宫颈癌预后的独立危险因素有年龄、宫颈间质浸润深度及淋巴结转移,神经侵犯尚不能做为影响宫颈癌预后的独立危险因素。更多还原

【Abstract】 Objective:To explore the incidence rate of perineural invasion in cervical cancer and analyze the correlation between perineural invasion and the clinicopathological features of cervical cancer.Furthermore,the study aims to assess the influence of perineural invasion on the prognosis of cervical cancer.The findings of this research will contribute valuable insights to reference for treatment in cervical cancer management.Methods:In this study,a cohort comprising a total of 215 patients diagnosed with cervical cancer who underwent surgical treatment at the First Hospital of Lanzhou University between January 1,2018,and November 31,2022 was selected as the study population.The patients’ preoperative disease staging was determined according the International Federation of Gynecology and Obstetrics(FIGO)criteria in 2018,falling within the range of IA2 to IIA2.Clinicopathological data of the patients were collected,and telephone or outpatient follow-up was conducted to record the date of recurrence or death of the patients.The follow-up deadline was May 31,2024.The 215 patients with cervical cancer were stratified into two categories based on the presence of perineural invasion:the positive group and the negative group.A comparative analysis was conducted between these groups encompassing various clinical parameters,hypertension,diabetes,hyperlipidemia,FIGO stage,histological subtype,degree of tissue differentiation,parametrial invasion,lymphovascual space invasion,depth of cervical stromal invasion,lower uterine segment invasion,lymph node metastasis,and positive surgical margins.Variables exhibiting statistically differences were subjected to binary logistic regression analysis to identify independent risk factors associated with perineural invasion.Furthermore,the survival outcomes for the two groups were assessed using Kaplan-Meier method to estimate survival rates and construct survival curves,with inter-group differences evaluated via the Log-rank test.Subsequently,univariate and multivariate analyses were carried out employing the Cox regression to analyze whether perineural invasion is an independent risk factor for progression-free Survival(DFS)and Overall Survival(OS)of cervical cancer.Results:1.This study encompassed an analysis of 215 patients diagnosed with cervical cancer,among whom 30 were found to have perineural invasion,resulting in a positive rate of 13.95%,while 185 patients were negative for perineural invasion,yielding a negative rate of 86.05%.2.Univariate analysis revealed significant associations between the occurrence of perineural invasion and several factors,including FIGO stage,hypertension,degree of tissue differentiation,parametrial invasion,lymph node metastasis,and lymphovascual space invasion(P<0.05).Conversely,no statistically significant disparities were observed in relation to diabetes,hyperlipidemia,histological type,depth of cervical stromal invasion,positive surgical margin,and lower uterine segment invasion(P>0.05).The multivariate analysis identified FIGO stage(OR=3.464,95%CI:1.365-7.894,P=0.009),lymphovascual space invasion(OR=3.027,95%CI:1.158-7.914,P=0.024),and degree of tissue differentiation(OR=2.924,95%CI:1.088-7.862,P=0.033)as independent risk factors for perineural invasion.3.Survival analysis demonstrated that patients in the perineural invasion positive group exhibited significantly shortened OS and DFS compared to those in the perineural invasion-negative group(P<0.05).4.The univariate analysis on factors affecting DFS in cervical cancer showed that age,FIGO stage,depth of cervical stromal invasion,lymph node metastasis,lymphovascual space invasion,perineural invasion,lower uterine segment invasion and parametrial invasion were factors associated with DFS of cervical cancer(P<0.05).Multivariate COX regression showed that age(HR=1.079,95%CI:1.024-1.137,P=0.004),depth of cervical stromal invasion(HR=3.736,95%CI:1.274-10.959,P=0.016)and lymph node metastasis(HR=4.543,95%CI:1.536-13.432,P=0.006)were independent risk factors affecting DFS of cervical cancer.5.The univariate analysis on factors affecting OS in cervical cancer showed that age,FIGO stage,depth of cervical stromal invasion,lymphovascual space invasion,perineural invasion and lymph node metastasis were identified factors influencing OS of cervical cancer(P<0.05).Multivariate COX regression showed that age(HR=1.111,95%CI:1.045-1.180,P=0.001),depth of cervical stromal invasion(HR=5.279,95%CI:1.650-16.890,P=0.005)and lymph node metastasis(HR=5.560,95%CI:1.603-19.284,P=0.007)were independent risk factors affecting OS of patients with cervical cancer.Conclusions:1.The incidence of perineural invasion in cervical cancer is 13.95%.The presence of perineural invasion is significantly associated with several factors,including hypertension,degree of tissue differentiation,FIGO stage,parametrial invasion,lymphovascual space invasion,and lymph node metastasis.Notably,Late FIGO stage,low tissue differentiation and positive lymphovascual space invasion are independent risk factors for perineural invasion of cervical cancer.Consequently,when these risk factors are present,clinicians should maintain a heightened vigilance for perineural invasion.2.The DFS and OS rates observed in the perineural invasion-positive group were markedly inferior to those of the perineural invasion-negative group,indicating that perineural invasion is a significant prognostic indicator in the context of cervical cancer.3.The prognosis of cervical cancer is influenced by a number of independent risk factors,including patient age,depth of cervical stromal invasion,and lymph node metastasis.However,it is noteworthy perineural invasion is not considered as a independent risk factors affecting the prognosis of cervical cancer.更多还原