新疆地区早期宫颈鳞状细胞癌根治术后预后因素及不同治疗模式的疗效分析

Analysis of prognostic factors and different treatment modalities for patients with early cervical squa- mous cell carcinoma after surgery in Xinjiang

目的 探讨早期宫颈鳞状细胞癌根治术后影响其预后的危险因素及术后不同治疗模式的疗效。方法回顾性分析130例早期宫颈鳞状细胞癌根治术后患者的临床病理资料，并随访5年以死亡为结局，应用Kaplan—Meier法计算生存率，对可能影响患者预后的因素分别进行单因素分析（Logrank检验），应用Cox回归模型进行多因素分析。结果单因素分析显示产次（矿=7．378，P=0．007）、FIGO分期（r=4．124，P=0．042）、肿瘤大小（X2=4．070，P=0．044）、淋巴结转移（X2=11．936，P=0．001）、治疗方式（X2=8．523，P=0．014）、术前鳞状细胞癌抗原（SCCA）（X2=6．399，P=0．011）、术前血小板与淋巴细胞比值（PLR）（X2=5．588，P=0．018）是5年生存率的影响因素。多因素分析显示产次（OR=4．379，95％CI为1．492—12．854，X2=7．226，P=0．007）、FIGO分期（OR=4．129，95％CI为1．401—12．168,X2=7．827，P=0．005）、淋巴结转移（OR=7．312，95％CI为2．617～20．430，X2=14．819，P=0．000）、治疗方式（OR=0．242，95％CI为0．082—0．713，X2=6．662，P=0．010）、PLR（OR=5．375，95％CI为1．351～21．375,X2=5．862，P=0．017）是影响宫颈鳞状细胞癌预后的独立危险因素。106例有高危因素的宫颈鳞状细胞癌患者中，单纯手术、手术加放疗、手术加同期放化疗的5年生存率分别为61．8％、83．3％、90．4％，差异具有统计学意义（X2=8．467，P=0．014）。结论产次、FIGO分期、淋巴结转移、治疗方式、PLR是影响宫颈鳞状细胞癌预后的独立危险因素，对宫颈鳞状细胞癌术后有高危因素的患者建议术后辅助治疗，可以提高患者生存率和生命质量。

Objective To explore prognostic factors and different treatment modalities efficacy for patients with early cervical squamous cell carcinoma postoperative. Methods The clinical pathologic parameters in 130 inpatients of cervical squamous cell carcinoma after surgical were retrospectively analyzed. The patients were followed up for 5 years. The survival rate was calculated by Kaplan-Meier method and the difference was compared by Log-rank test. Multivariate analysis was performed using Cox regression model. Results Univariate analysis showed that parity （X2 = 7. 378, P = 0. 007 ） , Federation International of Gynecology and Obstetrics （FIGO） stage （X2 =4. 124, P =0. 042）, tumor size （X2 =4. 070, P =0.044）, lymph node metastasis （X2 = 11. 936, P = 0. 001 ）, treatment approach （X2 = 8. 523, P = 0.014）, serum level of squamous cell carcinoma antigen （SCCA） （X2 = 6. 399, P = 0. 011 ）and platelet and lymphocyte ratio （PLR） （X2 = 5. 588, P = 0. 018 ） impact on the 5-year survival rate. Multivariate analysis showed that parity （ OR =4. 379, 95% CI： 1. 492-12. 854, ,12 = 7. 226, P = 0.007）, FIGO stage （ OR = 4. 129, 95% CI： 1. 401-12. 168, X2= 7. 827, P = 0.005 ） , lymph node metastasis （ OR = 7.312, 95% CI： 2. 617-20. 430, X2 = 14.819, P = 0.000）, treatmerit approach （ OR = 0.242, 95% CI： 0. 082-0.713, Xz = 6. 662, P = 0. 010） and PLR （ OR = 5. 375, 95 % CI： 1. 351-21. 375, X2 = 5. 862, P = 0. 017） were independent prognostic factors for cervical squamous cell carcinoma patients. In 106 cases of patients with risk factors of cervical squamous cell carcinoma, patients who having surgery alone, surgery plus radiotherapy, surgery plus chemoradiotherapy had 5-year survival rates of 61.8% , 83.3% and 90.4% , respectively, and the difference was statistical significant （X2 = 8. 467, P = 0. 014）. Conclusion Parity, FIGO stage, lymph node metastasis, treatment approach and PLR are independent prognostic factors in patients with early cervical squamous cell carcinoma. Adjuvant therapy is recommended in cervical cancer patients with risk factors after operation, it can improve patients＇ survival rates and quality of life.