2004—2016年我国宫颈癌住院患者FIGO临床分期应用情况调查

Survey of the application status of FIGO clinical staging system in cervical cancer in China between 2004 and 2016

目的调查了解FIGO临床分期在我国宫颈癌住院患者中的应用情况。方法对国内34家三级甲等医院在2004年1月至2016年12月期间收治的31 599例宫颈癌住院病例进行回顾性调查,记录患者初诊时的原始FIGO临床分期,参照同时期的FIGO临床分期标准,分析FIGO临床分期的应用情况。结果 31 599例宫颈癌病例中,16 044例(50.8%)来源于综合性医院,13 822例(43.7%)来源于肿瘤专科医院,1733例(5.5%)来源于妇幼专科医院。共6020例(19.1%)宫颈癌病例存在分期不规范,分期不规范的分类包括分期不完整如ⅠB期、Ⅱ期等(3265例,54.24%)、未进行临床分期(2395例,39.78%)、与妇检描述不符合(182例,3.02%)、模糊分期如ⅠB2~ⅡA1期等(102例,1.69%)和术后进行分期修正(76例,1.26%)。对分期是否规范的相关因素如年龄、医院类型、是否教学医院及大体类型进行分析,结果发现,≥60岁的患者分期不规范的比例明显高于其他年龄段(20.75%vs.18.52%vs.19.39%,P<0.001);大体类型为外生型的病例中,分期不规范的比例明显低于其他类型;妇幼专科医院分期不规范的比例明显低于肿瘤专科医院和综合性医院(3.75%vs.14.53%vs.24.58%,P<0.001)。结论宫颈癌住院患者中,相当一部分病例存在FIGO临床分期不规范的情况。分期不规范多见于年龄>60岁、非外生型病变等分期参数判定较为困难的病例。

Objective To investigate the application status of FIGO clinical staging system in cervical cancer in China. Methods A total of 31 599 cases of cervical cancer during the period from January 2004 to December 2016 were retrospectively reviewed.The original clinical stages were recorded and entered into a database.The standardized degree of clinical stage was evaluated by referring to the corresponding FIGO clinical staging system.Results Among the 31 599 cases, 16 044（50.8%）were from general hospitals, 13 822 （43.7%） from special tumor hospitals and 1733 （5.5%） from special women and children＇s hospitals.Non-standard application of FIGO clinical staging system were found in 6020 cases.Incomplete clinical staging （3265, 54.24% ） and no clinical staging（2395,39.78% ）were the two most common forms of non-standard application, followed by discordance with gyneeologic examination （182,3.02%） ; ambiguous staging such as I B2- 1I A1, et al （ 102, 1.69% ） and stage revision postoperatively （76, 1.26% ）.Based on analyses of associated factors, we found that age〉 60 was associated positively with non-standard application of FIGO clinical staging （20.75% vs. 18.52% vs. 19.39%, P〈0.001 ） ;Exogenous growth pattern and maternal health care [lospital were associated negatively with non- standard application of FIGO clinical staging （3.75% vs. 14.53% vs. 24.58%,P〈0.001）.Conelusion Non-standard application of F1GO clinical stage was not uncommon and it oceurrs more frequently in diffieuh situations such as old patients or non-exogenous growth patterns.