那不勒斯预后评分预测FIGO分期Ⅰ~Ⅱ期宫颈癌患者术后复发和转移的临床价值

The Predictive Value of Naples Prognostic Score in FIGO Stage Ⅰ-Ⅱ Cervical Cancer Patients with PostoperativeRecurrence and Metastasis

目的:探讨那不勒斯预后评分(Naples prognostic score,NPS)在国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期Ⅰ~Ⅱ期宫颈癌患者术后复发和转移的预测价值。方法:回顾性收集186例FIGOⅠ~Ⅱ期宫颈癌患者的临床资料,根据NPS分为低危组(0分)、中危组(1~2分)和高危组(3~4分),比较各组间临床特征的差异。根据患者是否复发和转移分为无复发转移组(147例)和复发转移组(39例),比较2组患者的临床特征差异。采用COX回归分析患者复发转移的影响因素,采用Kaplan-Meier法比较不同NPS患者的无病生存期(disease free survival,DFS)。结果:NPS低危、中危和高危组白蛋白、中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR),淋巴细胞-单核细胞比值(lymphocyte-monocyte ratio,LMR)、分化程度和宫旁浸润比例比较,差异均有统计学意义(均P<0.05)。COX回归分析结果显示,NPS是宫颈癌患者复发转移的独立预后因素(HR_(高危vs.低危)=14.304,95%CI:3.214~63.656,P<0.001)。亚组分析结果显示,鳞癌患者NPS高危组的DFS明显低于中危组和低危组(Log-rankχ^(2)=23.267,P<0.001);FIGO分期Ⅰ期和Ⅱ期患者NPS高危组的DFS明显低于中危组和低危组(Log-rankχ^(2)分别为15.760和8.294,P<0.05)。结论:NPS是FIGO分期Ⅰ~Ⅱ期宫颈癌患者术后复发转移的独立影响因素,NPS较高的患者DFS相对较短。

Objective:To investigate the prognostic value of Naples prognostic score(NPS)in predicting postoperative recurrence and metastasis of cervical cancer in patients with stageⅠ-Ⅱcervical cancer according to the International Federation of Gynecology and Obstetrics(FIGO).Methods:The clinical data of 186 patients with FIGOⅠ-Ⅱcervical cancer were collected retrospectively.The patients were divided into low-risk group(0),medium-risk group(1-2)and high-risk group(3-4)according to NPS.Patients were divided into non-recurrence or metastasis group(n=147)and recurrence or metastasis group(n=39)according to whether they had relapsed or not,and the differences in clinical characteristics between the two groups were compared.COX proportional hazards regression was used to analyze the factors influencing patients′recurrence or metastasis.Kaplan-Meier method was used to compare the difference of disease-free survival(DFS)among patients with different NPS patients.Results:There were statistically significant differences in albumin,neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),degree of differentiation and proportion of parametrial infiltration in low-risk,medium-risk and high-risk NPS groups(all P<0.05).COX regression analysis showed that NPS was an independent prognostic factor for recurrence or metastasis in patients with cervical cancer(HR_(high-risk vs.low-risk)=14.304,95%CI:3.214-63.656,P<0.001).Subgroup analysis showed that DFS in NPS high-risk group was significantly lower than that in medium-risk group and low-risk group(Log-rankχ^(2)=23.267,P<0.001).Patients with FIGO stageⅠandⅡhad significantly lower DFS in the NPS high-risk group than in the medium-risk and low-risk groups(Log-rankχ^(2)=15.760 and 8.294,respectively,P<0.05).Conclusions:NPS is an independent influencing factor of postoperative progress of patients with FIGOⅠ-Ⅱcervical cancer,and patients with higher NPS have relatively shorter DFS.