中晚期宫颈癌的临床特点与筛查策略分析

Analysis of clinical characteristics and screening strategies in advanced cervical cancer

目的分析中晚期宫颈癌的临床特点,探讨筛查策略。方法收集239例宫颈癌患者的临床资料,按其FIGO分期分组,其中早期（Ⅰa1-Ⅰb2期）组91例（38.1%）、中晚期（Ⅱ-Ⅳ期）组148例（61.9%）,比较2组的临床特征。结果早期组患者发病年龄为（46.8±10.3）岁,高峰年龄段为40-50岁,中晚期组发病年龄为（52.6±9.9）岁,高峰年龄段为45-60岁,2组发病年龄比较差异有统计学意义（P〈0.001）。早、中晚期组患者中,年龄≤35岁患者分别占14.3%、4.1%,2组比较差异有统计学意义（P〈0.01）;绝经后发病者分别占30.8%、52.7%,2组比较差异有统计学意义（P〈0.01）。早期组患者中城市户籍、农村户籍分别占44.0%、56.0%,中晚期组为17.6%、82.4%,2组比较差异有统计学意义（P〈0.001）;早期组患者文化程度为小学及以下、中学、大专及以上分别占31.9%、50.5%、17.6%,中晚期组患者相应为49.3%、45.3%、5.4%,2组比较差异亦有统计学意义（P〈0.01）。中晚期组患者临床首发症状为接触性阴道流血者比例低于早期组患者（26.4%、45.1%,P〈0.01）。结论与早期宫颈癌患者相比,中晚期宫颈癌患者具有发病年龄晚、绝经后发病比例高、农村户籍所占比例高、文化水平相对低、不易被早发现的特点。因此,为了早期发现宫颈癌变,改善宫颈癌患者预后及生活质量,需要合理分配社会医疗资源,适当调整政府政策,更应关注文化水平低的农村中年妇女。

Objective To analyze the clinical characteristics of advanced cervical cancer,and to explore new screening strategy. Methods 239 cases of patients with cervical cancer were collected,according to the FIGO staging. 91 patients（ 38. 1%） were in early stage（ FIGO Ⅰa1-Ⅰb2） of cervical cancer,while 148patients（ 61. 9%） were in advanced stage（ FIGO Ⅱ-Ⅳ）,the clinical features between the two groups were compared. Results The onset age was（ 46. 8 ± 10. 3） years old in the early group,whose peak ages were at the range of 40 to 50 years old,the age of onset in advanced group was（ 52. 6 ± 9. 9） years old,whose peak ages were at the range of 45 to 60 years old,there was significant difference between the two groups（ P〈0. 001）. In early and advanced group,age less than or equal to 35 years old accounted for 14. 4% and 4. 1%,respectively（ P〈0. 01）; and after postmenopause,the incidence of onset were 30. 8% and 52. 7%,respectively,there was statistically difference between the two groups（ P〈0. 01）. In early group of patients,household registration of urban and rural accounted for 44% and 56%,respectively,while in advanced stage group of patients,which accounted 17. 6% and 82. 4%,respectively,there were statistically difference between the two groups（ P〈0. 001）. The education level of elementary school or below,secondary school,college or above accounted for 31. 9%,50. 5% and 17. 6% respectively in early group,and in advanced stage group of patients which education degree were corresponding 49. 3%,45. 3% and 5. 4% respectively,the difference was also statistically significant between the two groups（ P〈0. 01）. Contact bleeding as first symptom in the advanced groups was found in 26. 4% patients,significantly lower than 45. 1% in the early group（ P〈0. 01）.Conclusions Compared with patients in early stage cervical cancer,advanced cervical cancer patients have characteristics of late onset ages,high proportion in postmenopausal women,high proportion of rural household registration,relatively low level of culture and difficult finding. Thus,in order to find early cervical cancer,and improve the prognosis and life quality of patients,it is of great necessary to reasonably reallocate social resources,appropriately adjust government policy,and more attention should be given to the low culture level of rural middle-aged women.