ⅠB期子宫颈癌国际妇产科联盟2018新分期的合理性验证及评估

Rationality verification and evaluate of the 2018 International Federation of Gynecology and Obstetrics staging system for stageⅠB cervical cancer

目的从疾病特征、生存预后等方面,验证及评估子宫颈癌国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)2018年新分期体系对ⅠB期重新分期的合理性。方法参照FIGO 2018年新分期的修订内容,选取2010年1月1日至2014年12月31日于首都医科大学附属北京妇产医院行首选手术治疗的子宫颈癌患者进行重新分期,共采集到427例ⅠB1~ⅠB3期的子宫颈癌患者进行回顾性分析。利用组间比较、多因素分析等统计学方法,对ⅠB期各个亚期患者的临床病例信息包括年龄、肿瘤特征(组织学类型、分化程度、深部间质受侵、淋巴脉管间隙浸润情况)、治疗方式(术后辅助放射治疗,化学药物治疗情况)以及5年生存率进行分析。结果鳞癌、高中分化癌以ⅠB1期患者居多,而腺癌、腺鳞癌及低分化癌多见于ⅠB2、ⅠB3期患者,差异有统计学意义(P均<0.001)。ⅠB2、ⅠB3期患者宫颈深部间质浸润率高于ⅠB1期,差异有统计学意义(P<0.001)。ⅠB2、ⅠB3期淋巴脉管间隙浸润阳性率高于ⅠB1期,差异有统计学意义(P<0.05)。ⅠB2、ⅠB3期患者术后补充放射治疗化学药物疗的比率高于ⅠB1期,差异有统计学意义(P均<0.001)。ⅠB2、ⅠB3期患者术后补充放射治疗,化学药物治疗的比率高于ⅠB1期,差异有统计学意义(P均<0.001)。ⅠB1、ⅠB2、ⅠB3期患者的5年总生存率依次减低,分别为97.9%、93.4%、81.5%,构建生存曲线显示各组曲线分离良好,差异有统计学意义(P<0.001)。结论2018年新分期体系在ⅠB期中增加肿瘤最大径线2 cm这一临界值,重新修订新分期为ⅠB1期(≤2 cm)、ⅠB2期(>2 cm~≤4 cm)和ⅠB3期(>4 cm)能够更精确地对疾病严重程度进行分层和评估预后,具有很好的临床指导意义。

Objective The paper aimed to verify and evaluate the stageⅠB of the revised 2018 International Federation of Gynecology and Obstetrics(FIGO)cervical cancer staging schema from the aspects of clinical characteristics and prognosis,etc.Methods This is a retrospective observational study examining 427 patients from January 1,2010 to December 31,2014 with cervical cancer of stageⅠB1-ⅠB3 classified using the 2018 FIGO staging schema.The clinical characteristic including age,tumor characteristics(Including pathological type,histological grade,deep stromal invasion and infiltration of lymphatic vascular space),treatment(postoperative adjuvant radiotherapy and chemotherapy)and 5-year survival rate were estimated for each group by statistical methods such as group comparison and multi factor analysis.Results StageⅠB1 tumors were more likely to be squamous cell and well-moderate grade,whereas the adenocarcinoma,adenosquamous cell and poorly grade were more common in stageⅠB2-ⅠB3 neoplasms(both P<0.001).The rates of deep stromal invasion and lymph-vascular space invasion(LVSI)in stageⅠB2 andⅠB3 tumors were significantly higher than stageⅠB1(P<0.001,P<0.05).The probability of postoperative radiotherapy and chemotherapy in stageⅠB2 andⅠB3 cohorts were significantly higher than that with stageⅠB1(P<0.001).The 5-year overall survival rate in stageⅠB1,ⅠB2 andⅠB3 diseases significantly different and decreased in turn,which were 97.9%,93.4%and 81.5%respectively.The survival curve showed that the curves of each group were well separated,and the difference was statistically significant(P<0.001).Conclusion The FIGO 2018 staging schema revised the new system toⅠB1(≤2 cm),ⅠB2(>2 cm~≤4 cm)andⅠB3(>4 cm),with invasive carcinoma 2 cm in greatest dimension is regarded as a cut off value,which provides better stratification of the disease and prognostic evaluation for patients of stageⅠB,and has a good clinical guiding significance.