ⅠA～ⅡB期子宫颈鳞癌预后影响因素的临床分析

Analysis of prognostic factors ofⅠA～ⅡB squamous carcinoma of the cervix

目的探讨ⅠA-ⅡB期宫颈鳞癌患者预后的相关临床高危因素。方法对2004年11月—2013年7月在北京大学人民医院接受广泛/次广泛子宫切除术＋盆腔淋巴结切除/取样术的296例ⅠA-ⅡB期宫颈鳞癌患者的临床病理资料进行回顾性分析。结果 296例宫颈鳞癌患者中,按国际妇产科联盟（FIGO）2009临床分期：ⅠA期33例,ⅠB期143例,ⅡA期61例,ⅡB期59例。患者3年生存率为96%,5年生存率为87%,总体生存率为87%。单因素分析显示,临床分期、新辅助化疗、脉管内癌栓、宫颈间质浸润深度、宫旁浸润、盆腔淋巴结转移、盆腔淋巴结阳性数目与宫颈鳞癌预后密切相关（P〈0.05）;多因素分析显示,盆腔淋巴结阳性数目（P=0.003）及宫颈间质浸润深度（P=0.026）是影响ⅠA-ⅡB期宫颈鳞癌患者预后的独立危险因素。结论ⅠA-ⅡB期宫颈鳞癌患者若盆腔淋巴结阳性数目〉2和（或）宫颈间质浸润深度〉1/2,预后往往较差。

Objective The study aimed to evaluate the high-risk prognostic factors ofⅠA-ⅡB squamous carcinoma of the cervix.Methods The case records of 296 patients withⅠA-ⅡB cervical squamous carcinoma who underwent extensive/sub-extensive hysterectomy＋ pelvic lymphadenectomy/pelvic lymph node（PLN）sampling in Peking University People＇s Hospital from November 2004 to July 2013 were collected,data was analyzed retrospectively.Results Among the 296 cases,33women were in stageⅠ（FIGO stages）,143 women stageⅠB,61 women stageⅡA and 59 women were stageⅡ B.Three-year survival rate was 96%,five-year survival rate was 87%and overall survival rate was 87%.Univariate analysis showed that clinical stage,neoadjuvant chemotherapy,lymph vascular space involvement（LVSI）,the depth of stroma invasion,parametrial extension,pelvic lymph node metastasis（LNM）and the number of positive pelvic lymph nodes were closely related to the prognosis（P〈0.05）.Multivariate analysis demonstrated that the number of positive pelvic lymph nodes（P=0.003）and the depth of stroma invasion（P=0.026）were the independent clinicopathologic factors for prognosis in patients with stageⅠA-ⅡB squamous carcinoma of the cervix.Conclusions Patients with the depth of stroma invasion〉1/2and/or the number of positive pelvic lymph nodes〉2had poor survival outcome inⅠA-ⅡB squamous carcinoma of the cervix.