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淋巴血管侵犯(lymphovascular invasion,LVI)虽已被报道为宫颈癌患者预后的一个独立预测指标。然而,并非所有研究都支持其具有独立的预后意义,尤其是在多因素分析中。一种应用于宫颈腺癌的风险分层系统被报道可以很好地预测子宫颈腺癌的淋巴结(lymph node,LN)转移风险。有一组具有C结构特征的宫颈腺癌患者易有淋巴结转移和死于该病。在本研究中,我们研究LVI在这组病例中是否有任何额外的临床意义。我们收集了127例C结构特征且随访12个月及以上的宫颈腺癌患者。这些肿瘤被分成3亚组。无LVI和LN阴性组41例,其中大多数患者(36例,88%)在最后的随访期内均无病生存,4例(10%)死于肿瘤复发或转移。有LVI但无LN组55例,10(18%)例出现复发,其中5例死于肿瘤复发,剩余5例患者带瘤生存。有LVI和LN组31例,13(42%)例出现复发,其中11(85%)例死于肿瘤复发,2人带瘤生存。另外1例晚期肿瘤患者也死亡。单因素分析显示,肿瘤大小、水平扩散及阳性LN数目与预后密切相关,而在多因素分析未发现统计学意义。并且,肿瘤浸润深度不是一个独立的预后指标。无LVI和阴性LN的肿瘤侵袭性明显低于有LVI和阳性LN的肿瘤(P<0.01)。LVI状态(独立于LN状况)与患者预后的关系虽然趋近统计学有意义,但无明显相关(P=0.06)。总之,LVI虽然是淋巴结转移的一个先决条件,但其本身不足以预测肿瘤的侵袭性,而且超过50%的LN阳性患者死于LVI,根据LVI和LN状态,将C结构特征的宫颈腺癌分为不同亚组可以进一步确定C结构特征肿瘤患者的治疗。
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