多高危风险因素对手术治疗早期子宫颈癌患者的影响

Impacts of multiple high-risk factors on outcomes of early-stage cervical cancer patients after surgical treatment

目的评估多高危风险因素对经手术治疗的早期子宫颈癌患者生存结局的重要性。方法回顾性分析158例给予手术治疗的早期子宫颈癌患者（ⅠA2~ⅡB期）。检测手术病理学风险因素,纳入肿瘤表现≥1项高危因素的子宫颈癌患者。基于高危风险数量和辅助治疗类型进行生存分析。结果早期子宫颈癌患者中61例（38.6%）具有多高危因素,其中52例（32.9%）具有2项高危因素,9例（5.7%）具有3项高危因素。多高危因素是与早期子宫颈癌不良无瘤生存期（disease-free survival,DFS）和总生存期（overall survival,OS）相关联的独立预测因子（HR=2.38,P〈0.01;HR=2.41,P=0.005）。伴多项高危风险因素的子宫颈癌患者中,接受同步放化疗（concurrent chemo-radiotherapy,CCRT）治疗的患者5年累积局部复发（10.1%vs 29.7%;HR=0.43,P=0.065）和远端复发（46.2%vs 40.5%;HR=1.05,P=0.910）与仅接受RT治疗的患者差异无统计学意义。结论在管理手术治疗早期子宫颈癌患者过程中,多高危因素不利于患者DFS和OS、增加远端复发风险并且不利于CCRT治疗。

Objective To assess the impact of multiple high-risk factors on the outcomes of early-stage cervical cancer patients after surgical treatment. Methods A retrospective study was conducted for 158 cases of surgically treated early-stage cervical cancer patients（ ⅠA2 –ⅡB stage）. Patients with at least one high-risk factor were enrolled and their surgical-pathological risk factors were analyzed. Survival analysis was performed based on the number of high-risk factors and the types of adjuvant therapy. Results Among all patients,61 cases（ 38. 6%） had multiple high-risk factors,including 52（ 32. 9%） with 2 high-risk factors and 9（ 5. 7%） with 3 high-risk factors. The presence of multiple high-risk factors was an independent prognostic factor for poor disease-free survival（ HR = 2. 38,P〈 0. 01） and overall survival（ HR =2. 41,P = 0. 005）. Among patients with multiple high-risk factors,there were no significant differences in 5-year cumulative locoregional recurrence rates（ 10. 1% vs 29. 7%; HR = 0. 43,P = 0. 065） and distant recurrence rates（ 46. 2% vs 40. 5%;HR = 1. 05,P = 0. 910） between patients receiving concurrent chemo-radiotherapy（ CCRT） and those receiving radiotherapy alone. Conclusion Multiple risk factors affect disease-free survival and overall survival negatively,and increase the risk of distal recurrence and impair CCRT treatment for surgically treated patients with early-stage cervical cancer.