子宫颈鳞癌Ⅰb～Ⅱa期患者预后预测系统的建立及其临床意义

Analysis of prognostic factors in patients with cervical squamous cell carcinoma of stage Ⅰb and Ⅱa

目的 分析子宫颈鳞癌Ⅰb～Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用.方法 回顾性分析接受手术治疗的306例Ⅰb～Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析.结果 306例患者的5年生存率为78.1%.单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0.05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0.05).根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90.3%、 83.9%和 43.1%.低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2.2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13.5%,远处转移的发生率为1.3%, 局部复发合并远处转移的发生率为0.6%;高危组(淋巴结转移或合并其他危险因素) 局部复发和远处转移的发生率分别为25.9%和48.3%,局部复发合并远处转移的发生率为10.3%.结论 淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb～Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗.

Objective To analyze the prognostic factors in patients with cervical squamous cell carcinoma of stage Ⅰb and Ⅱa treated by surgery,and to investigate their guid roles in available post-operation adjuvant therapy. Methods The clinicopathologic records of 306 patients with cervical squamous cell carcinoma of stage Ⅰb and Ⅱa who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factors were identified by COX proportional hazards regression model. Results The overall 5-year survival rate of these 306 patients was 78.1%. In univariate survival analysis, the poor prognostic factors included poor differentiation, positive pelvic lymph nodes, deep stromal invasion, parametrial extension, tumor size≥4 cm, and lymph vascular space involvement (P<0.05). While in multivariate survival analysis, the independent prognostic factors included positive pelvic lymph nodes, deep stromal invasion and parametrial extension (P<0.05). According to the risk factors, all patients were divided into low, intermediate and high risk groups with 5-year survival rate of 90.3%, 83.9% and 43.1%,respectively. In low risk group, no risk factor or only parametrial extension was involved, pelvic recurrence rate was only 2.2%. In intermediate risk group, deep stromal invasion or together with parametrial extension was involved. Pelvic recurrence rate and extra pelvic metastasis rate were 13.5% and 1.3%, respectively. In high risk group, lymph node metastasis or together with other high risk factors was involved, pelvic recurrence rate and extra pelvic metastasis rate were 25.9% and 48.3%, respectively, and 10.3% had both pelvic recurrence and extra pelvic metastasis. Conclusions Lymph node metastasis, deep stromal invasion and parametrial extension were independent prognostic factors of stage Ⅰb and Ⅱa cervical squamous cell carcinoma patients undergoing radical hysterectomy and lymphadenectomy. The establishment of prognosis-predicting system based on high risk factors may be helpful to predict the risk of recurrence and metastasis, and guide adjuvant therapy after surgery.