老年宫颈癌患者治疗结局及预后分析

Analysis of treatment outcome and prognosis of elderly patients with cervical cancer

目的宫颈癌是我国目前死亡率最高的妇科恶性肿瘤,其死亡率随年龄的增长而升高。本研究旨在探讨老年(≥60岁)宫颈癌患者治疗结局、生存及影响预后的相关因素。方法回顾性分析重庆市肿瘤医院2006-01-01-2016-12-31收治的563例≥60岁原发宫颈癌患者的临床资料,随访其生存状况,分析影响预后因素。结果 563例患者年龄60~90岁,平均年龄(68.02±4.24)岁,中位年龄65岁;鳞癌518例(92.00%),非鳞癌45例(8.00%)。参照国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期标准,Ⅰ期81例,Ⅱ期254例,Ⅲ期193例,Ⅳ期31例,未能分期4例。合并高血压174例(30.91%),合并糖尿病87例(15.45%)。未治疗102例(18.12%),单纯手术者31例(5.51%),非标准治疗者59例(10.48%),手术联合术后放疗/放化疗者87例(15.45%),单纯放疗者70例(12.43%),放疗联合化疗者214例(38.01%)。放疗同步化疗组患者生存时间长于其他治疗组(χ2=145.465,P<0.001),手术±术后放化疗患者生存时间与单纯放疗相比差异无统计学意义(χ2=0.565,P=0.452),而非标准治疗组生存时间与未治疗组相似,χ2=0.855,P=0.269。结论年龄、FIGO分期、病理组织类型和盆腔淋巴结转移仍是影响老年宫颈癌患者预后的重要因素。放疗同步化疗是老年宫颈癌患者的最佳治疗方式,获得的生存期最长。

OBJECTIVE Cervical cancer is the most common gynecological malignancy in China,and its mortality increases with age.The purpose of this study was to investigate the outcome,survival and prognostic factors of elderly cervical cancer patients.METHODS A retrospective analysis of 563 patients with cervical primary malignant tumor,who had been treated in Chongqing Cancer Hospital from January 1 st,2006 to December 31 st,2016 was performed.Clinical data and survival times of patients aged 60 or elder were collected.RESULTS All the patients aged 60 to 90.The patients＇ average age was 68.02±4.24 and median age was 65 years.Among them,518 cases（92.00%）were squamous cell carcinoma,45 cases（8.00%）were non-squamous cell carcinoma.According to the International Federation of Gynecology and Obstetrics（FIGO）staging criteria,81 cases were stageⅠ,there were 254 cases of stdgeⅡ,193 cases of stageⅢ,31 cases of stageⅣ,and 4 cases failed staging.174 cases（30.91%）with hypertension,87 cases（15.45%）with diabetes.102 cases（18.12%）did not accept treatment,31 cases（5.51%）received surgery alone,59 cases（10.48%）with non-standard treatment,70 cases（12.43%）received radiotherapy alone,87 cases（15.45%）with chemotherapy combined with postoperative radiotherapy,and 214 cases（38.01%）with concurrent chemo-radiotherapy.The median survival time of concurrent chemo-radiotherapy was significantly longer than that of other treatment groups（χ2=145.465,P〈0.001）.The median survival time was not different between chemo-radiotherapy after surgery and radiotherapy alone group（χ2=0.565,P=0.452）,while the non-standard treatment between untreated group is as the same（χ2=0.855,P=0.269）.CONCLUSIONS FIGO staging,treatment,pathological type and lymphatic metastasis are independent risk factors influencing the prognosis of elderly people with cervical cancer.Concurrent chemo-radiotherapy will be the best treatment for these patients.