子宫颈癌2018年FIGO新分期ⅢC期患者预后分析

The prognostic value of revised 2018 FIGO stageⅢC in cervical cancer

背景与目的:国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)2018年子宫颈癌新分期增加了ⅢC期。但是,ⅢC期这类患者存在高度异质性,其预后差异可能较大。探讨子宫颈癌2018年FIGO新分期系统对ⅢC期患者预后的预测价值。方法:采用病例对照研究方法,根据纳入和排除标准,连续收集2011年1月—2014年12月重庆大学附属肿瘤医院妇科肿瘤中心收治的子宫颈癌Ⅲ期患者的临床病历资料,回顾性分析生存状况及影响预后的相关因素。采用Kaplan-Meier法计算生存率;单因素生存分析采用log-rank检验;多因素生存分析采用COX比例风险回归模型。结果:纳入研究病例418例,其中ⅢA期42例(10.0%),ⅢB期120例(28.7%),ⅢC1期190例(45.5%),ⅢC2期66例(15.8%)。在4组人口学特征中,年龄差异有统计学意义(P=0.003);其他包括组织学类型、组织分化、肿瘤大小、放射治疗类型、是否巩固化疗差异均无统计学意义(P>0.05)。生存分析显示,ⅢC1期患者5年生存率为54.1%,高于ⅢB期的40.6%及ⅢA期的43.3%,但差异无统计学意义(P=0.042及P=0.484)。ⅢC2期患者5年生存率仅为23.1%,均显著低于其他组(P<0.01)。多因素模型分析显示,ⅢC1期较ⅢA(HR=1.432,95%CI:0.867~2.366,P=0.161)和ⅢB期(HR=1.261,95%CI:0.871~1.827,P=0.219)均没有明显增加死亡风险;ⅢC2期独立增加死亡风险为ⅢA期近3倍(HR=2.958,95%CI:1.757~4.983,P<0.001)。基于T分期ⅢC1期患者预后存在显著差异(5年生存率T1为72.2%,T2为54.1%,T3为18.6%,P<0.001)。多因素模型分析显示,T分期是影响ⅢC1期患者预后的独立危险因素(P<0.001)。ⅢC1(T1)期患者5年生存率反而显著高于ⅢA期(P=0.004)和ⅢB期(P<0.001)。基于病理学分期及影像学分期ⅢC1期患者预后差异显著,ⅢC1p(T1/T2a)期患者5年生存率为64.5%,明显高于ⅢC1r(T2b/T3)期的34.9%(P<0.001);ⅢC1p(T1/T2a)期患者预后反而显著优于ⅢB期患者(P<0.001)。结论:ⅢC2期能准确预测预后,但ⅢC1期患者预后异质性较大,其预后判断还需要结合T分期。

Background and purpose:The International Federation of Gynecology and Obstetrics(FIGO)2018 revised the staging system for cervical cancer with new stageⅢC.However,patients with stageⅢC exhibit heterogeneous clinical characteristics,and the prognosis is different.This study aimed to investigate the prognostic value of 2018 FIGO new stage system for cervical cancer patients in stageⅢC.Methods:A case-control study was conducted to collect the clinical data of patients with stageⅢcervical cancer treated in Gynecological Oncology Center,Chongqing University Cancer Hospital from January 2011 to December 2014 according to the inclusion and exclusion criteria.The survival status and prognostic factors were analyzed retrospectively.Kaplan-Meier method was used to calculate the survival rate.Log-rank test was used for univariate survival analysis,and Cox proportional hazards regression model was used for multivariate survival analysis.Results:A total of 418 cases were included in the study,in which stageⅢA had 42 cases(10.0%),stageⅢB had 120 cases(28.7%),stageⅢC1 had 190 cases(45.5%)and stageⅢC2 had 66 cases(15.8%).There was significant difference in age among the four groups(P=0.003).There was no significant difference in histological type,histological differentiation,tumor size,radiotherapy type and consolidation chemotherapy(P>0.05).Survival analysis showed that the 5-year overall survival(OS)rate of stageⅢC1 disease was 54.1%,higher but not statistically significant compared with stageⅢB(40.6%,P=0.042)andⅢA(43.3%,P=0.484).The stageⅢC2 had a significantly worse OS compared with stageⅢC1,ⅢA andⅢB(P<0.01),and 5-year OS rate was 23.1%forⅢC2.Multivariate analysis showed that the stageⅢC1 disease did not increase the risk of death compared with stageⅢA(HR=1.432,95%CI:0.867-2.366,P=0.161)andⅢB(HR=1.261,95%CI:0.871-1.827,P=0.219).The risk of death was nearly 3 times higher inⅢC2 than inⅢA(HR=2.958,95%CI:1.757-4.983,P<0.001).The survival of stageⅢC1 disease differed significantly based on T stage(P<0.001).Multivariable analysis showed T stage remained an independent prognostic factor for survival in patients with stageⅢC1 disease,and 5-year OS rate was 72.2%for T1,54.1%for T2 and 18.6%for T3(P<0.001).The 5-year OS rate of stageⅢC1(T1)patients was 72.2%with better 5-year OS compared with stageⅢA(P=0.004)andⅢB(P<0.001).Based on the pathological stage and imaging stage,the 5-year OS rate of stageⅢC1p(T1/T2a)was 64.5%,which was significantly higher compared with stageⅢC1r(T2b/T3)(34.9%,P<0.001).The prognosis of patients with stageⅢC1p(T1/T2a)was significantly better than that of patients with stageⅢB(P<0.001).Conclusion:The prognosis of patients with stageⅢC2 disease has distinct characteristics.However,the stageⅢC1 is heterogeneous,and its prognostic evaluation should be combined with T stage.