局部巨块型宫颈癌患者手术治疗的疗效及预后分析

Clinical outcomes after surgical treatment for locally advanced bulky cervical cancer

目的观察局部巨块型宫颈癌(locally advanced bulky cervical cancer,LABCC)患者手术治疗的疗效,并分析相关预后指标,为临床实践提供参考。方法选取我中心妇产科2013年1月-2015年1月手术治疗的354例宫颈癌(ⅠA2-ⅡA2期)患者作为研究对象。根据国际妇产科联合会2009分期标准,将ⅠB2期(n=57)和ⅡA2期(n=34)局部病灶≥4 cm病例纳入LABCC组,将ⅠA2期(n=12)、ⅠB1期(n=189)和ⅡA1期(n=62)局部病灶<4 cm病例纳入对照组,比较两组围术期指标、并发症发生情况和生存指标。结果 LABCC组纳入91例,平均年龄(52.4±5.5)岁;对照组纳入263例患者,平均年龄(51.8±4.8)岁。LABCC组接受新辅助化疗比例高于对照组[69例(75.8%) vs 45例(17.1%),P<0.001],术中出血量[(598.1±135.3) ml vs (450.8±117.5) ml,P<0.001]和输血率[11例(12.1%) vs 14例(5.3%),P=0.030]高于对照组,术后住院时间长于对照组[(14.1±1.4) d vs (12.1±1.5) d,P<0.001],泌尿系损伤发生率高于对照组[5例(5.5%) vs 4例(1.5%),P=0.038];两组手术用时、淋巴结切除数以及其他并发症发生率无统计学差异(P>0.05)。LABCC组的5年累积生存率低于对照组(64.8% vs 82.1%,P=0.001),死亡率高于对照组(9.9% vs 4.2%,P=0.042),两组复发率差异无统计学意义(14.3% vs8.4%,P=0.103)。结论手术治疗LABCC疗效可靠,建议在新辅助化疗后进行手术,LABCC组较对照组5年生存率更低、死亡率更高。

Objective To observe the efficacy of surgical treatment in patients with locally advanced bulky cervical cancer (LABCC),analyze the relevant prognostic indicators,so as to provide evidence for clinical practice.Methods A retrospective comparative clinical study was conducted in 354 patients with cervical cancer (stageⅠA2-ⅡA2) who were treated in our hospital from January 2013 to January 2015.According to the FIGO2009 staging criteria,the stage ⅠB2 (n=57) and ⅡA2 (n=34) cases (lesion≥4 cm) were included in the LABCC group,while the stage ⅠA2 (n=12),ⅠB1 (n=189) and ⅡA1 (n=62) cases (lesion<4 cm) were included in the control group.General data,perioperative indicators,complications and survival analysis indicators were compared between the two groups.Results Of the 354 cases,91 patients were included in the LABCC group and 263 patients in the control group.Compared with the control group,more patients in LABCC group received neoadjuvant chemotherapy[69 cases (75.8%) vs45 cases (17.1%),P<0.001],LABCC group had more intraoperative blood loss ([598.1±135.3]ml vs[450.8±117.5]ml,P<0.001) and higher blood transfusion rate (11 cases[12.1%]vs 14 cases[5.3%],P=0.030),longer postoperative hospital stay ([14.1±1.4]d vs[12.1±1.5]d,P<0.001),and a higher incidence of urinary injury (5 cases[5.5%]vs 4 cases[1.5%],P=0.038).There was no statistical difference in operation duration,number of lymph node resected and other complications between the two groups (all P>0.05).The 5-year accumulate survival rate of the LABCC group was significantly lower than that of the control group (64.8% vs 82.1%,P=0.001),and the mortality rate was higher (9.9% vs 4.2%,P=0.042).There was no significant difference in the recurrence rate between the two groups (P>0.05).Conclusion The efficacy of surgical treatment for LABCC patients is reliable,and the surgery is recommended to be performed after NACT treatment.The 5-year survival rate of LABCC group is lower and the mortality rate is higher than that of early stage patients.