| Objective:Through retrospective analysis,the clinical characteristics,pathological characteristics,treatment methods and survival of patients with stage ⅢC cervical cancer were comprehensively described.To explore the predictive value of clinical data,imaging results and pathological features of patients with stage ⅢC cervical cancer on lymph node metastasis,and to explore the related factors affecting the prognosis of stage ⅢC cervical cancer,so as to provide clinical reference for diagnosis and treatment of stage ⅢC cervical cancer.Methods:According to International Federation of Gynecology and Obstetrics(FIGO)2009standard for cervical cancer staging,from January 2015 to January 2018,Gansu Maternal and Child Health Hospital was collected.There were 386 patients diagnosed with stage IB1-IIA2(feasible surgical treatment),whose clinical,imaging and pathological data were retrospectively analyzed.Finally,according to FIGO2018 cervical cancer staging system and treatment of patients with stage ⅢC cervical cancer,they were divided into ⅢCr and ⅢCp groups.The predictive value of clinical data,imaging results and pathological features of cervical cancer patients in the two groups was compared,and the related factors affecting the prognosis of ⅢC stage cervical cancer were analyzed.The follow-up period was 65 months(range 8-95 months)until January 2023.Results:1.According to the new staging system of FIGO 2018,a total of 95 cervical cancer patients who had undergone radical resection of cervical cancer had suspected positive lymph nodes on imaging(which could be diagnosed as stage ⅢCr)and lymph node metastasis confirmed by pathology after surgery(which could be diagnosed as stage ⅢCp).In this study,MRI examination of 95 patients showed lymph node metastasis(stage ⅢCr)in 65 cases(68.4%)(among which,imaging showed lymph node metastasis was pelvic lymph node involvement(stage ⅢC1r),and no metastasis in 30 cases(31.6%).Of the 95 cases,85 cases(89.4%)had final postoperative pathological confirmation(ⅢCp stage)(68 cases(71.5%)had pelvic lymph node metastasis(ⅢC1p stage),17 cases(17.9%)had para-aortic lymph node metastasis(ⅢC2p stage),and 10 cases(10.6%)had no metastasis.The pathological types at ⅢCr stage were squamous cell carcinoma in 10 cases(43%),adenocarcinoma and adeno-squamous cell carcinoma in 6 cases(9%),neuroendocrine carcinoma in 1 case(2%),and squamous cell carcinoma in 73 cases(86%),adenocarcinoma in 10 cases(12%),and neuroendocrine carcinoma in 2 cases(2%).48 patients(74%)received neoadjuvant chemotherapy before surgery,and 17 patients(26%)received direct surgery plus postoperative chemoradiotherapy.In ⅢCp stage,54 patients(63%)received neoadjuvant chemotherapy before surgery,and 31patients(37%)received direct surgery + postoperative chemoradiotherapy.Median survival time was 65 months(range 8-95 months),with 22 patients(23.1%)dying.2.Research analysis showed that lymph node diameter ≥10mm indicated by MRI and apparent diffusion coefficient value ≥0.7×10^ 3 mm~2/s indicated by MRI were independent risk factors for patients with stage ⅢCr cervical cancer(P<0.05).Lymphovascular space infiltration was an independent risk factor for patients with ⅢCp stage cervical cancer(P<0.05).3.Studies have shown that local tumor diameter and metastatic lymph node ratio > 0.20 are independent prognostic factors for patients with stage ⅢC cervical cancer.4.In this study,95 patients with stage ⅢC1 r 5-year OS were 87.2%(P =0.101,P > 0.05),respectively.The 5-year OS of ⅢC1 p stage and ⅢC2 p stage were 86.4% and 50% respectively(P<0.05),showing statistical difference.Conclusion:1.Surgical staging can better reflect the prognosis of patients with stage ⅢC cervical cancer than imaging staging.2.The apparent diffusion coefficient values of lymph node diameter and local tumor lesions detected by imaging MRI were significantly correlated with patients with stage ⅢCr cervical cancer.3.Lymphatic vascular space infiltration is an independent risk factor for ⅢCp stage cervical cancer patients.4.The prognosis of patients with cervical cancer at ⅢC stage is affected by the local tumor diameter and the ratio of metastatic lymph nodes,and the survival rate of patients with lymph node metastasis with different tumor diameter is heterogeneous,so the treatment of patients at ⅢC stage still needs to be discussed.5.The analysis of this study found that the accuracy of MRI evaluation of lymph node metastasis is not high,so it is worth exploring more MRI diagnostic parameters to predict lymph node metastasis in patients with cervical cancer,so as to provide more accurate treatment plans for patients with stage ⅢCr. |
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