1990-2007年4223例子宫颈癌住院患者的调查分析

Analysis of 4223 hospitalized patients with cervical cancer during 1990 -2007

目的分析不同时期宫颈癌住院患者的发病年龄、临床病理特征及治疗方式的变化，以期为宫颈癌的治疗策略提供参考。方法对1990年1月至2007年11月在江西省妇幼保健院住院、接受初次治疗的4223例宫颈癌患者的临床和病理资料进行回顾性分析，以2000年为分界点将宫颈癌患者分为1990-1999年（A组）和2000-2007年（B组），比较不同时期宫颈癌患者发病年龄、临床病理特征及治疗方式的变化。结果（1）A组宫颈癌患者平均发病年龄为54．4岁，B组平均发病年龄降至47.2岁。A组≤35岁宫颈癌患者的构成比为4.77％（89／1865），B组≤35岁者构成比增加至11.75％（277／2358），两组比较，差异有统计学意义（P〈0．01）。（2）A组Ⅱa期及以下宫颈癌患者的构成比为14.32％（267／1865），Ⅱb期及以上者构成比为85．68％（1598／1865）；B组Ⅱa期及以下者构成比增加至40．75％（961／2358），Ⅱb期及以上者构成比降至59．25％（1397／2358）；两组分别比较，差异均有统计学意义（P〈0．01）。（3）A组宫颈鳞癌、腺癌、腺鳞癌以及其他类型癌的构成比分别为88．42％、7．77％、1．88％和1．93％；B组分别为88.97％、8．02％、1．78％和1．23％。两组分别比较，差异均无统计学意义（P〉0．05），鳞癌仍是主要的病理类型。（4）A组单纯放疗是主要治疗方式，构成比为75．28％，化疗（包括单纯化疗、化疗＋其他治疗方式）的比例为10．89％；B组同步放化疗转变为主要治疗方式，构成比为35．79％，单纯手术的比例增加至19．47％。结论1990-2007年宫颈癌发病呈年轻化趋势，早期宫颈癌患者增多，化疗在宫颈癌的治疗中已越来越显示出其重要的地位。

Objective To analyze the changes in epidemiology and treatment of hospitalized patients with cervical cancer during 1990 -2007. Methods Overall, 4648 patients with cervical cancer were diagnosed in our hospital from Jan 1990 to Nov 2007, but only 4223 patients with initial treatment in our hospital were studied retrospectively. Pearson Chi-square test was used to compare the age, stage, histopathologic type and treatment methods between different times. Results （ 1 ） The mean age of cervical cancer patients gradually decreased over the past 18 years, from 54. 4 years during 1990 - 1999 to 47.2 years during 2000- 2007; the proportion of young patients aged ≤35 years increased from 4. 77% （89/1865） during 1990- 1999 to 11.75% （277/2358） during 2000- 2007. （2） The proportion of patients with cervical cancer （stage Ⅰ a- Ⅱ a） increased from 14. 32% （267/1865） during 1990 -1999 to 40. 75% （961/2358） during 2000 - 2007, whereas the proportion of patients with cervical cancer （ stage Ⅱb- Ⅳ） decreased from 85.68% （1598/1865） during 1990 - 1999 to 59. 25% （1397/2358） during 2000 -2007. （3） There was no significant change in histopathologic type of cervical cancer, and squamous cell carcinoma of cervix remained the main type of cervical cancer. （4） The treatment pattern of cervical cancer changed significantly： radiotherapy was the main method （75.28%） for cervical cancer during 1990- 1999, but during 2000 -2007, it was replaced by concurrent chemoradiotherapy （35.79%）. Conclusions The proportion of young women with cervical cancer was increased during 1990 - 2007, and at the same period early stage cervical cancer increased, but late stage cervical cancer decreased. It is obvious that chemotherapy has become the important therapy in cervical cancer.