52例原发性阴道癌临床分析

Clinical analysis of 52 cases of primary vaginal cancer

目的探讨原发性阴道癌的临床特点及影响预后的相关因素。方法选取2013年1月至2020年1月郑州大学第一附属医院妇科收治的有完整临床病理及随访资料的52例原发性阴道癌患者,回顾性分析患者的一般资料、不同治疗方法及整体预后情况。结果52例患者1、3、5年患者生存率分别为80.7%、61.1%、48.1%。其中鳞癌28例(53.8%),中位生存时间92个月;恶性黑色素瘤12例(23.0%),中位生存时间12个月。早期(Ⅰ期+Ⅱ期)、晚期(Ⅲ期+Ⅳ期)的5年生存率分别是61.0%和0.0%。Log-rank检验进行单因素分析结果显示,原发性阴道癌的FIGO分期、病理类型、肿瘤大小、治疗方式、肿瘤生长部位、阴道受侵长度与患者的预后有关(P均<0.05);COX多因素回归分析显示,2009FIGO分期(P=0.002)、病理类型(P=0.000)为影响原发性阴道癌患者预后的独立因素。不同病理类型中,鳞癌与恶性黑色素瘤的预后比较,差异有统计学意义(χ^(2)=17.704,P=0.000)。放化疗联合治疗与单独放疗或化疗比较,差异有统计学意义(χ^(2)=4.017,P=0.045)。结论原发性阴道癌的预后与病理类型及临床分期有关,临床期别越早,预后越好。其中鳞癌的生存周期远高于恶性黑色素瘤。治疗上以放疗为主,且放疗和化疗联合治疗的效果优于单独放疗或化疗。

Objective To investigate the clinical features and prognostic factors of primary vaginal cancer.Methods A total of 52 patients with complete pathological diagnosis and clinical follow-up data were selected from the first Affiliated Hospital of Zhengzhou University from January 2013 to January 2020.The general characteristics,different treatment methods and overall prognosis of the patients were analyzed.Results The1-year,3-year and 5-year survival rates of 52 patients with primary vaginal cancer were 80.7%,61.1%,and 48.1%,respectively.Among them,28 patients(53.8%)had squamous cell carcinoma,and the median survival time was 92months.There were 12 cases of malignant melanoma(23.0%),and the median survival time was 12 months The5-year survival rates of early stage(stageⅠ+stageⅡ)and late stage(stageⅢ+stageⅣ)were 61.0%and 0.0%,respectively.Univariate analysis showed that FIGO stage,pathological type,tumor size,treatment mode,tumor growth stage and vaginal invasion length were related to the prognosis of patients(P<0.05).COX multivariate regression analysis showed that 2009 FIGO stage(P=0.002)and pathological type(P=0.000)were independent factors affecting the prognosis of patients with primary vaginal cancer.The prognosis of different pathological types,such as squamous cell carcinoma and malignant melanoma,was significantly different(χ^(2)=17.704,P=0.000).There was statistically significant difference between combined radiotherapy and chemotherapy with radiotherapy or chemotherapy alone(χ^(2)=4.017,P=0.045).Conclusion The prognosis of primary vaginal cancer is related to pathological type and clinical stage.The earlier the clinical stage,the better the prognosis.The survival cycle of squamous cell carcinoma is much higher than that of malignant melanoma.The treatment is mainly radiotherapy,and the combined treatment of radiotherapy and chemotherapy is better than radiotherapy or chemotherapy alone.