ⅠB-ⅡA期年轻宫颈癌临床特点及预后分析

Clinical characteristics and prognostic analysis of young patients with stage ⅠB-ⅢA cervical cancer

目的 探讨年龄≤35岁ⅠB-ⅡA期宫颈癌患者的临床病理特点、生存情况及术后放疗对卵巢功能影响.方法 对2000-2011年本院收治的186例患者进行回顾分析,并根据期别进行配平选取同期年龄＞35岁宫颈癌患者186例作为对照.Kaplan-Meier法计算生存率Logrank法检验和单因素预后分析,Cox模型多因素预后分析.结果 年龄≤35岁组中非鳞状细胞癌所占比例高于对照组（P =O.000）,而肿瘤侵犯＞1/2宫颈间质、淋巴血管间隙受侵发生率低于对照组（P=0.008、0.000）.尽管年轻患者5年DFS和OS率均高于对照组（93.7％∶84.5％,P=0.005和96.1％∶89.5％,P=0.033）,但年龄本身并非预后影响因素（P=0.202、0.950）.在年龄≤35岁患者中淋巴结转移及淋巴血管间隙受侵为DFS的影响因素（P=0.000、0.000）,淋巴血管间隙受侵及治疗前肿瘤大小则是OS的影响因素（P=0.000、0.000）.接受卵巢移位术后外放疗的年轻患者63％卵巢功能正常,未接受的为73％ （P =0.422）.结论 ⅠB-ⅡA期宫颈癌中年龄≤35岁者预后优于对照组,但年龄本身并非预后影响因素.术后外放疗不会对移位后的卵巢功能造成影响.

Objective To investigate the clinicopathological features,survival,and the impact of postoperative adjuvant radiotherapy on the ovarian function in patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer.Methods One hundred and eighty-six patients who were admitted to our hospital from 2000 to 2011 were retrospectively analyzed.An equal number of patients older than 35 years of age with cervical cancer within the same period were used as stage-marched controls.The Kaplan-Meier method was used to calculate the survival rates,and the log-rank test was used for pairwise comparison and univariate prognostic analyses.The Cox proportional hazards model was used for multivariate prognostic analyses.Results The patients less than or equal to 35 years of age had a significantly higher incidence of non-squamous carcinoma but significantly lower incidence rates of deep stromal invasion and lymph-vascular space invasion （LVSI） compared with the control group （P =0.000;P =0.008;P =0.000）.Though young patients had significantly higher 5-year disease-free survival （DFS） and overall survival （OS） rates than the control group （93.7% vs.84.5%,P=0.005;96.1% vs.89.5%,P=0.033）,age was not an independent prognostic factor （P =0.202;P =0.950）.Among patients less than or equal to 35 years of age,lymph node metastasis and LVSI were independent prognostic factors for DFS （P =0.000;P =0.000）,while LVSI and initial tumor size were independent prognostic factors for OS （P =0.000;P =0.000）.There was no significant difference in the incidence of normal ovarian function between young patients treated with and without adjuvant radiotherapy after ovarian transposition （63% vs.73%,P =0.422）.Conclusions Patients less than or equal to 35 years of age with stage ⅠB-ⅡA cervical cancer have a better prognosis than the control group.However,age is not an independent prognostic factor.Postoperative adjuvant radiotherapy will not impair the function of transposed ovaries.