Correlation Between Eosinophilic Invasion And Clinical Pathology And Prognosis Of Cervix Squamous Carcinoma In ?B1-?A2 Phase

Objective:To observe the incidence of perineural invasion(PNI)in postoperative pathological specimens of patients with ?B1-?A2 stage cervical squamous carcinoma,analyze its relationship with various clinicopathological factors,and explore the impact of PNI on the prognosis and survival of patients.At the same time,it is used to guide assisted treatment after surgery.Methods:Retrospective analysis of 256 patients with cervical squamous cancer who underwent hysterectomy and pelvic lymph node resection from January 1,2010 to December 1,2013 at the Department of Gynecology,Shanxi Province,aged between 25 and 75.According to the 2009 International Federation of Obstetrics and Gynecology(FIGO2009)from ?B1 to ?A2,No treatment was received before the first operation,and the other tumor sources,pathology and follow-up data were excluded.The incidence of PNI was observed using S-100 immunohistochemical staining.The follow-up data included no tumor survival time and total survival time.The results of the prognosis of the selected patients,such as age,clinical staging,tumor classification,tumor diameter,depth of infiltration,lymph node metastasis,vascular infiltration,and positive incisional edge,were statistically analyzed,and the qualitative data were compared with each other.Fisher's exact probability method is used for those who do not meet the conditions.Non-conditional Logitic regression was used to perform a multi-factor analysis of the prognosis,reporting the odds ratio(OR)and its 95 % CI.The Kaplan-Meier method calculates the survival rate and draws the survival curve.The inter-group survival comparison uses the Log-rank test,and the Cox proportional risk regression model analyzes the factors affecting the lifetime of cervical squamous cancer and reports the risk ratio(hazard ratio,HR)and its 95%confidence interval(CI).The test level takes bilateral?=0.05,the difference of P<0.05 was statistically significant.Results:1.Of the 256 patients with cervical squamous carcinoma,118 were ?B1,26 were ?B2,83 were ?A1 and 29 were IIIA(FIGO 2009 staging).Of the 249 cases(97.27 %),7cases(2.73 %),225 cases(2.73 %),and 34 cases of recurrent metastasis during the follow-up period,24 of them died due to transfer of different parts of the body.The median age is 50 years(range 25-75 years)and the peak age of onset is 40-58 years(60.7 %);The total survival rate of patients for 5 years accounted for 90.4 %,and the non-tumor survival rate(DFS)was 86.3 %.2.The incidence of eosinophilic invasion in 256 patients with cervical squamous carcinoma was 8.6 %(22/256),and 91.4 %(234/256)without eosinophilic invasion.The average age of patients with PNI was(50.1 ± 9.0)years old,and the average age of patients without PNI was(50.3 ± 9.8)years old.The difference between the two groups was not statistically significant(P>0.05).The probability of existence of PNI is closely related to clinical staging.The incidence of PNI in IIA 2 period is the highest(20.7 %),followed by ?B2 period(15.4 %).There is a tendency for the higher the incidence of clinical staging later,and the difference is statistically significant(P < 0.05).The incidence of PNI was higher in patients with tumor size>4cm,infiltration depth>1/2,vascular gap infiltration,lymph node metastasis than in patients with tumor size?4cm,infiltration depth ?1/2,no vascular gap infiltration,and no lymph node metastasis.The single factor analysis showed that PNI positive was closely related totumor size,infiltration depth,vascular gap infiltration,and lymph node metastasis(P < 0.05).However,tumor grade and cutting margin were not correlated(P>0.05).Multiple factor logistic regression analysis showed that infiltration depth > 1/2 and positive lymph node metastasis were independent risk factors for PNI occurrence(P<0.05)3.The single factor analysis of logarithmic rank and test of Log-rank of 249 patients with cervical squamous carcinoma completed the follow-up showed that the factors that had a significant influence on the five-year survival rate of cervical squamous cell carcinoma patients were: staging(?B1 phase vs ?B2 phase vs ?A1 phase vs ?A2 phase,P<0.001),lymph node metastasis(With vs None,P<0.001),vascular cancer suppository(With vs None,P<0.001),tumor size(>4cm vs ? 4cm,P<0.001),infiltration depth(>1/2 vs? 1/2,P = 0.015),PNI(with vs none,P<0.001).The age(? 45 years vs <45 years old,P = 0.878),degree of differentiation(high vs low in high vs low,P = 0.511)and vaginal cut edge positive(with vs None,P = 0.851)has no statistical significance for the overall five-year survival rate after surgery.Multi-factor analysis related to the prognosis of cervical squamous carcinoma,lymph node metastasis,vascular infiltration,muscle infiltration depth,and PNI had a statistically significant effect on the prognosis of cervical squamous carcinoma in phase I?B1-?A2(P<0.05),Can be used as an independent factor that affects the prognosis.Conclusion:1.Clinical staging,tumor size,lymph node metastasis,vascular infiltration,muscle infiltration depth,and neurophilic invasion are the factors that significantly affect the5-year survival rate of cervical squamous carcinoma in the ?B1-?A2 phase.Lymph node metastasis,vascular infiltration,infiltration depth,and neurophilic invasion can also be used as independent risk factors for affecting prognosis.2.The occurrence of PNI is closely related to clinical staging,tumor size,infiltration depth,vascular metastasis(LVSI)and lymph node metastasis,and infiltration depth greater than 1/2 and positive lymph node metastasis are independent risk factors that affect PNI occurrence.The 5-year survival rate of PNI positive patients is lower.It may be a new risk factor for the prognosis of cervical squamous carcinoma.