影响手术治疗宫颈癌患者预后的因素分析

Prognostic factors of stage Ⅰ B and Ⅱ A carcinoma of cervix treated by surgery

目的探讨影响ⅠB期和ⅡA期宫颈癌预后的高危因素。方法手术治疗的40例宫颈浸润癌,按国际妇产科联盟(FIDO)分期标准,ⅠB期25例(ⅠB1期15例和ⅠB2期10例),ⅡA期15例;鳞癌33例,腺癌6例,小细胞癌1例。40例患者均采用广泛性子宫切除加以撕剥式为主的盆腔淋巴清扫术,术前辅助放疗26例,术后辅助治疗14例。结果ⅠB1期、ⅠB2期、ⅡA期有效率分别为73%(11/15)、70%(7/10)、67%(10/15)。全组患者5年生存率为85%,其中ⅠB1期为93%,ⅠB2期为90%,ⅡA期为80%。结论肿瘤大小、肿瘤类型、临床分期、淋巴结转移、颈管受侵、深肌层浸润和多个性伴侣+合并妊娠与早期宫颈癌预后有关。

Objective To evaluate prognostic factors in patients with stage Ⅰ B-Ⅱ A of cervical carcinoma treated by surgery. Methods 40 patie＇nts with stage Ⅰ B-Ⅱ A cervical cancer surgically treated were analyzed. Median age 40 cases,according to FIGO staging system： ⅠB 25（ Ⅰ B1 15, ⅠB2 10） and Ⅱ A 15. There were 33 cases of squamous cell carcinoma, 6 cases of adeno carcinoma and 1 case of small cell carcinoma. All patients were treated by radical hysterectomy and pelvic lymphadeneetomy, 26 patients had preoperative adjuvant radiotherapy, 14 patients had postoperative adjuvant treatment. Results The efficiency rates for Ⅰ Bl, Ⅰ B2, ⅡA were 73 96 （11/15 ）, 70 96 （7/10） ,67 96 （10/15）, respectively. The overall 5-year survival rates were 85 96,93 96,90 96 and 80 96 for stage Ⅰ B1, Ⅰ B2 and ⅡA, respectively. Conclusions Univariate analysis shows that tumor size, tumor type, clinical stage, adjuvant treatment, lymph node metastasis, endocervical involvement, depth of myometrial invasion and multiple sexual partners during pregnancy are of prognostic significance. The latter two are the most important factors indicative of poor prognosis.