Li P P, Su Y H, Zhang M Z
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Cervical Disease Prevention and Treatment Engineering Center of Henan Province, Zhengzhou 450000, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Apr 25;55(4):266-272. doi: 10.3760/cma.j.cn112141-20200114-00033.
To investigate the clinical characteristics of patients with hepatic metastasis after cervical cancer operation, and analyze the risk factors and prognostic factors of hepatic metastasis. A total of 1 312 patients with stage Ⅰa2-Ⅱb2 cervical cancer received radical surgery from January 2013 to January 2016 in the First Affiliated Hospital of Zhengzhou University were collected, of which 13 cases (0.99%, 13/1 312) had hepatic metastasis after operation. A retrospective analysis was conducted on clinical features of patients with hepatic metastasis after cervical cancer operation. T-test, chi-square test, rank sum test and logistic regression were used to analyze the risk factors of hepatic metastasis after surgery of cervical cancer operation. Kaplan-Meier method was used for survival analysis. Log-rank test was used for screening of prognostic factors in patients with postoperative hepatic metastasis. (1) Clinical features: there were 3 cases of simple hepatic metastasis without obvious clinical symptoms, 2 patients with perihepatic lymph node metastasis showed only low back pain, 8 patients with multiple extrahepatic metastases, and their clinical symptoms were related to the site of metastasis. Five cases out of 9 (5/9) with liver metastasis had abnormal tumor marker results. The abnormal kinds of tumor markers were mainly carcinoembryonic antigen (CEA), CA(125), CA(199), and CA(72-4). The interval time of hepatic metastasis after operation was 2-22 months. (2) Analysis of risk factors for hepatic metastasis: univariate analysis showed that lymph node metastasis, histological type, infiltration depth, and lymph-vascular space invasionwere associated with hepatic metastasis after cervical cancer surgery (<0.05).Multivariate analysis showed that lymph node metastasis and small cell carcinoma were independent risk factors for postoperative hepatic metastasis (<0.05). (3) Prognostic factors in patients with hepatic metastasis:among 13 patients with postoperative hepatic metastases from cervical cancer, 9 died during the follow-up period and 4 survived. The median total survival time after hepatic metastases was 7 months (range 3-32 months). Univariate analysis showed that multiple extrahepatic metastases and treatment after hepatic metastasis had significant effects on the prognosis of patients with hepatic metastasis after cervical cancer operation (<0.05). The interval of hepatic metastasis after surgery for cervical cancer operation is within 2 years. Patients with lymph node metastasis and small cell carcinoma are more prone to postoperative hepatic metastasis. The prognosis of patients with extrahepatic multiple metastases is poor, and individualized treatment should be carried out after comprehensive analysis for patients with hepatic metastasis after cervical cancer operation.
探讨宫颈癌术后肝转移患者的临床特征，分析肝转移的危险因素及预后因素。收集2013年1月至2016年1月在郑州大学第一附属医院接受根治性手术的1 312例Ⅰa2 - Ⅱb2期宫颈癌患者，其中13例（0.99%，13/1 312）术后发生肝转移。对宫颈癌术后肝转移患者的临床特征进行回顾性分析。采用t检验、卡方检验、秩和检验及logistic回归分析宫颈癌手术患者术后肝转移的危险因素。采用Kaplan - Meier法进行生存分析。采用log - rank检验筛选术后肝转移患者的预后因素。（1）临床特征：单纯肝转移无明显临床症状者3例，肝周淋巴结转移仅表现为腰痛者2例，肝外多发转移8例，其临床症状与转移部位有关。9例肝转移患者中有5例（5/9）肿瘤标志物结果异常。肿瘤标志物异常种类主要为癌胚抗原（CEA）、CA125、CA199和CA72 - 4。术后肝转移间隔时间为2 - 22个月。（2）肝转移危险因素分析：单因素分析显示，淋巴结转移、组织学类型、浸润深度及脉管间隙浸润与宫颈癌术后肝转移有关（P<0.05）。多因素分析显示，淋巴结转移和小细胞癌是术后肝转移的独立危险因素（P<0.05）。（3）肝转移患者的预后因素：13例宫颈癌术后肝转移患者中，随访期间9例死亡，4例存活。肝转移后总生存时间中位数为7个月（范围3 - 32个月）。单因素分析显示，肝外多发转移及肝转移后治疗对宫颈癌术后肝转移患者的预后有显著影响（P<0.05）。宫颈癌手术术后至肝转移的间隔时间在2年内。有淋巴结转移及小细胞癌的患者术后更易发生肝转移。肝外多发转移患者预后差，对宫颈癌术后肝转移患者应综合分析后进行个体化治疗。
