伴中度危险因素早期宫颈癌患者术后预后影响因素及治疗方案选择策略研究

Influencing factors of postoperative prognosis and treatment options strategy of patients with early cervical cancer with moderate risk factors

目的探讨伴中度危险因素早期宫颈癌患者术后预后影响因素及治疗方案选择策略。方法回顾性分析2015年1月至2020年12月于商丘市第一人民医院接受手术治疗伴中度危险因素早期宫颈癌患者共162例临床资料,分析复发转移情况,采用单因素和多因素评价患者术后预后独立影响因素,比较不同治疗方案和危险因素亚组生存获益。结果①162例患者中出现复发转移32例,其中伴1个和2~3个危险因素患者分别为15例,17例;②伴2~3个危险因素患者肿瘤直径≥4 cm和同步放化疗比例均显著高于伴1个危险因素患者(P<0.05);③单因素和多因素分析结果证实,肿瘤直径和治疗方案是伴中度危险因素早期宫颈癌患者术后无进展生存时间独立影响因素(P<0.05);危险因素数量和治疗方案是伴中度危险因素早期宫颈癌患者术后总生存时间独立影响因素(P<0.05);④5年无进展生存率和总生存率分别为79.01%,84.57%。化疗组、放疗组及同步放化疗组5年无进展生存率高于随访观察组(P<0.05)。放疗组和同步放化疗组5年总生存率均高于随访观察组(P<0.05);放疗和同步放化疗组5年无进展生存率和总生存率均高于化疗组(P<0.05);⑤伴1个危险因素人群化疗组5年无进展生存率显著高于随访观察组(P<0.05);放疗组和同步放化疗组5年无进展生存率/总生存率高于随访观察组、化疗组(P<0.05);⑥伴2~3个危险因素人群同步放化疗组5年无进展生存率高于化疗组(P<0.05);同步放化疗组5年无进展生存率/总生存率均高于放疗组(P<0.05)。结论伴中度危险因素早期宫颈癌患者术后生存时间与肿瘤直径、危险因素数量及治疗方案有关;其中对于伴2~3个中度危险因素者采用同步放化疗更有助于改善临床预后。

【Objective】To investigate the influencing factors of postoperative prognosis and treatment options strategy of patients with early cervical cancer with moderate risk factors.【Methods】Clinical data of 162 patients with early cervical cancer with moderate risk factors by surgery were retrospectively chosen in the period from January 2015 to December 2020.The recurrence and metastasis were analyzed.Univariate and multivariate analysis were used to evaluate the independent prognostic factors.The survival benefits of different treatment regimens and risk factors subgroups were compared.【Results】①Among 162 patients,32 cases had recurrence and metastasis and included 15 cases with 1 risk factor and 17 cases with 2 to 3 risk factors.②The proportion of tumor diameter≥4cm and concurrent chemoradiotherapy in patients with 2 to 3 risk factors were significantly higher than with 1 risk factor(P<0.05).③The results of univariate and multivariate analysis confirmed that tumor diameter and treatment regimen were independent factors of progression free survival in patients with early cervical cancer with moderate risk factors(P<0.05).The number of risk factors and treatment regimen were independent factors of overall survival time in patients with early cervical cancer with moderate risk factors(P<0.05).④The 5-year progression free survival rate and overall survival rate were 79.01%and 84.57%,respectively.The 5-year progression free survival rate of chemotherapy group,radiotherapy group and concurrent chemoradiotherapy group were significantly higher than follow-up observation group(P<0.05).The 5-year overall survival rate of radiotherapy group and concurrent chemoradiotherapy group was significantly higher than follow-up observation group(P<0.05).The 5-year progression free survival rate and overall survival rate of radiotherapy and concurrent chemoradiotherapy groups were significantly higher than chemotherapy group(P<0.05).⑤Patients with 1 risk factor:The 5-year progression free survival rate of chemotherapy group was significantly higher than follow-up observation group(P<0.05).The 5-year progression free survival rate/overall survival rate of radiotherapy group and concurrent chemoradiotherapy group was significantly higher than follow-up observation group and chemotherapy group(P<0.05).⑥Patients with 2 to 3 risk factor:The 5-year progression free survival rate in concurrent chemoradiotherapy group was significantly higher than chemotherapy group(P<0.05).The 5-year progression free survival rate/overall survival rate of concurrent chemoradiotherapy group was significantly higher than radiotherapy group(P<0.05).【Conclusion】The survival time of early stage cervical cancer patients with moderate risk factors was related to tumor diameter,number of risk factors and treatment plan;concurrent chemoradiotherapy in patients with 2 to 3 moderate risk factors was more helpful to improve the clinical prognosis.