493例Ⅰ-ⅡA期宫颈癌根治术后残端复发相关因素分析

Analysis of prognostic factors for recurrence of vaginal stump in 493 cases of stage Ⅰ-ⅡA cervical cancer after radical hysterectomy

目的探讨早期宫颈癌根治术后患者出现阴道残端复发的相关因素以及对预后的影响。方法回顾分析贵州省肿瘤医院2007-2016年间收治初诊的Ⅰ-ⅡA期宫颈癌根治术后患者临床资料分析。结果 493例随访至 2018 年5月30日,随访率96.6%(474/493),中位年龄 45 岁,高发年龄40~50岁。451例(91.48%)无复发,平均无残端复发时间51.2个月,中位无残端复发时间44.8个月。Cox模型多因素分析显示盆腔外照射、后装治疗是阴道残端复发的影响因素(P=0.000、0.000),肿瘤最大直径、淋巴结转移及盆腔外照射是影响总生存的因素(P=0.045、0.022、0.000)。结论盆腔外照射及近距离治疗对降低Ⅰ-ⅡA期宫颈癌根治术后阴道残端复发的风险尤其重要,肿瘤最大直径、淋巴结转移情况、盆腔外照射是影响Ⅰ-ⅡA期宫颈癌根治术后总生存的因素。

Objective To explore the prognostic factors for the recurrence of vaginal stump of early-stage cervical cancer after radical hysterectomy and evaluate the effect on clinical prognosis.Methods Clinical data of stage Ⅰ-ⅡA cervical cancer patients undergoing radical hysterectomy in Guizhou Cancer Hospital from January, 2007 to December, 2016 were retrospectively analyzed.Results A total of 493 patients were enrolled and followed up until May 30, 2018.Among them, 96.6%(474/493) completed the follow-up.The median age was 45 years. Patients aged 40-50 years had a high incidence rate.In total, 451 cases (91.48%) had no recurrence of vaginal stump. The average time without stump recurrence was 51.2 months and the median time without stump recurrence was 44.8 months. MultivariateCox regressionanalysis demonstrated that pelvic external irradiation and brachytherapy were the independent prognostic factors for the recurrence of vaginal stump (P=0.000,0.000).Tumor size, lymph node metastasis and pelvic external irradiation were the independent prognostic factors for overall survival (P=0.045,0.022,0.000).Conclusions Pelvic external irradiation and brachytherapy play an extremely pivotal role in reducing the risk of vaginal stump recurrence after radical hysterectomy for patients with stage Ⅰ-Ⅱ A cervical cancer. Tumor size, lymph node metastasis and pelvic external irradiation are the independent prognostic factors for overall survival of patients with stage Ⅰ-ⅡA cervical cancer following radical hysterectomy.