宫颈癌156例术后复发及预后相关因素分析
发布时间：2018-07-22 10:30
【摘要】：目的：探讨我院宫颈癌手术治疗后复发及预后的临床病理相关因素、临床特点、治疗方式，为减少我院宫颈癌术后复发，提高宫颈癌患者手术后生存率及改善预后提供依据。 方法：选择2007年1月1日至2008年12月31日期间河北医科大学第四医院妇科收治的，经手术治疗、有病理诊断、病历资料及随访资料完整的156例（依据国际妇产科联盟2009年分期）宫颈癌患者，共有22例患者复发，采用回顾性分析，统计临床病历资料、病理资料及随访资料。156例患者均符合以下的纳入标准：①所有患者均行宫颈癌根治术（广泛子宫切除术+盆腔淋巴结清扫术），并且经术后病理证实为宫颈癌；②复发的诊断:主要通过病理诊断，肿瘤再次出现部位的活检及穿刺病理证实；其次为临床诊断发生远处肺、骨转移无法获得病理诊断，可依靠症状、体征及辅助检查进行诊断[2]；③临床病历资料、病理资料完整，有比较规范、系统的随访资料。所有病例都采用电话随访方式。随访开始于所有治疗完成后，随访时间截止到2013年12月，末次随访覆盖全部入组的研究对象。患者生存时间是指从患者接受手术当日到末次随访时间或该研究对象死亡的这段时间。患者复发时间是指从患者接受手术当日到该研究对象复发的这段时间。对研究对象的年龄、临床分期、原发肿瘤大小、病理类型、肿瘤的组织分化程度、肌层浸润深度、有无脉管瘤栓、有无盆腔淋巴结转移、不同治疗方式等可能的复发及预后影响因素进行单因素和（或）多因素分析。本研究采用SPSS13.0软件包进行统计学分析，采用Kaplan-Meier法统计生存率，并绘制相应生存曲线，生存率及复发相关因素对比使用log-rank test，使用COX比例风险回归模型对单因素检验中有统计学意义（P0.05）的各影响因素进行复发及预后的多因素分析。统计分析结果均以P0.05代表有统计学意义。对于随访期间肿瘤以外因素死亡的患者及末次随访时仍然存活、未复发的患者，统计分析时均当作截尾数据处理。 结果： 1156例宫颈癌患者中有22例复发，，全组的复发率为14.10%。单因素分析显示临床分期较早组（≤Ⅰb2期）宫颈癌患者的复发率(9.30%)明显低于临床分期较晚组（＞Ⅰb2期）患者的复发率(20.00%)，差异有统计学意义（χ2=4.395，P=0.036）；鳞癌组患者的复发率(12.23%)明显低于腺癌及其他病理类型组患者的复发率（29.41%），差异有统计学意义（χ2=5.409，P=0.020）；无脉管瘤栓组患者的复发率（10.61%）明显低于有脉管瘤栓组患者的复发率（33.33%），差异有统计学意义（χ2=13.824，P=0.000）；无盆腔淋巴结转移组患者的复发率（11.02%）明显低于有盆腔淋巴结转移组患者的复发率（27.59%），差异有统计学意义（χ2=22.455，P=0.000）；即临床分期、病理类型、有无脉管瘤栓、有无盆腔淋巴结转移对宫颈癌患者复发的影响有统计学意义。而年龄、原发肿瘤大小、肿瘤的组织分化程度、肌层浸润深度、不同治疗方式对宫颈癌患者复发的影响无统计学意义（P＞0.05)。多因素分析显示有无脉管瘤栓是决定宫颈癌术后复发的独立因素，P值为0.004。 2156例宫颈癌患者中有31例死亡，全组的5年生存率为80.13%，单因素分析显示临床分期较早组（≤Ⅰb2期）宫颈癌患者的5年生存率(88.37%)明显高于临床分期较晚组（＞Ⅰb2期）患者的5年生存率（70.00%），差异有统计学意义（χ2=8.767，P=0.003）；鳞癌组患者的5年生存率（83.21%）明显高于腺癌及其他病理类型组患者的5年生存率（57.89%），差异有统计学意义（χ2=12.078，P=0.001），浅肌层浸润组患者的5年生存率（87.14%）明显高于深肌层浸润组患者的5年生存率（74.42%），差异有统计学意义（χ2=4.172，P=0.041）；无脉管瘤栓组患者的5年生存率（84.85%）明显高于有脉管瘤栓组患者的5年生存率（54.17%），差异有统计学意义（χ2=13.824，P=0.000）；无盆腔淋巴结转移组患者的5年生存率（86.61%）明显高于有盆腔淋巴结转移组患者的5年生存率（51.72%），差异有统计学意义（χ2=8.487，P=0.004），而年龄、原发肿瘤大小、肿瘤的组织分化程度、不同治疗方式对宫颈癌术后5年生存率的影响无统计学意义，多因素分析显示临床分期、有无脉管瘤栓、有无盆腔淋巴结转移是影响宫颈癌术后5年生存率的独立因素，P值分别为0.016、0.043和0.002。 结论： 1临床分期、病理类型、有无脉管瘤栓、有无盆腔淋巴结转移是影响宫癌术后复发的临床病理因素。其中有无脉管瘤栓是决定宫颈癌术后复发的独立因素。 2临床分期、病理类型、肌层浸润深度、有无脉管瘤栓、有无盆腔淋巴结转移是影响宫颈癌术后5年生存率的临床病理因素，其中临床分期、有无脉管瘤栓、有无盆腔淋巴结转移是影响宫颈癌术后5年生存率的独立因素。
[Abstract]:Objective: To explore the clinicopathological factors, clinical features and treatment methods of the recurrence and prognosis of cervical cancer after surgical treatment in our hospital, in order to reduce the recurrence of cervical cancer in our hospital, improve the survival rate and improve the prognosis of cervical cancer patients.
Methods: from January 1, 2007 to December 31, 2008, the gynecologic department of Fourth Hospital of Hebei Medical University was treated with surgical treatment. There were 156 cases of cervical cancer with pathological diagnosis, medical records and follow-up data (according to the 2009 staging of the International Union of Obstetrics and Gynecology). There were 22 cases of recurrence. The retrospective analysis was used to analyze the clinical records. Data, pathological data and follow-up data were all in accordance with the following criteria: (1) all patients were treated with radical hysterectomy (extensive hysterectomy plus pelvic lymphadenectomy) and cervical cancer confirmed by postoperative pathology; and (2) the diagnosis of recurrence: the diagnosis of recurrence mainly through the diagnosis of the disease, the biopsy and puncture of the tumor in the reappearance site. It was confirmed that the next clinical diagnosis of distant lung, bone metastasis can not be pathological diagnosis, can rely on symptoms, signs and auxiliary examination of the diagnosis of [2]; 3. Clinical records, pathological data complete, a relatively standardized, systematic follow-up data. All cases are followed by electric telephone follow up. Follow up after all treatment, follow all treatment, follow. The duration of the patient's survival time refers to the period of time from the day of the operation to the last follow-up or the death of the subject. The time of the patient's recurrence refers to the time from the day of the operation to the relapse of the subject. Age, clinical staging, primary tumor size, pathological type, degree of tissue differentiation, depth of myometrium infiltration, or without vascular tumor thrombus, pelvic lymph node metastasis, possible recurrence and prognostic factors such as different treatments were analyzed by single factor and (or) multivariate analysis. The SPSS13.0 software package was used for statistical analysis. The Kaplan-Meier method was used to calculate the survival rate, and to draw the corresponding survival curve, the survival rate and the recurrence related factors were compared with log-rank test, and the COX proportional risk regression model was used to analyze the factors of statistical significance (P0.05) in the single factor test for the recurrence and prognosis of the multifactorin analysis. The statistical analysis results were all P0.05 representative statistics. For patients who died of tumor factors during follow-up and at the last follow-up, they were still alive, and those who did not relapse were treated as truncated data.
Result:
22 of the 1156 patients with cervical cancer relapsed, and the recurrence rate of the whole group was 14.10%. single factor analysis. The recurrence rate of the early clinical stage group (9.30%) was significantly lower than that of the late clinical stage group (> I B2 stage). The recurrence rate was 20% (20%), and the difference was statistically significant (x 2=4.395, P=0.036), and the patients in the squamous cell carcinoma group had a relapse. The recurrence rate (12.23%) was significantly lower than that of the adenocarcinoma and other pathological types (29.41%), and the difference was statistically significant (x 2=5.409, P=0.020); the recurrence rate (10.61%) in the non vascular tumor thrombus group (10.61%) was significantly lower than that of the patients with vascular tumor thrombus group (33.33%), and the difference was statistically significant (x 2=13.824, P=0.000); no pelvic lymph node transfer was found. The recurrence rate of the group (11.02%) was significantly lower than that of the pelvic lymph node metastasis group (27.59%), and the difference was statistically significant (x 2=22.455, P=0.000), that is, the clinical stage, the pathological type, the vascular tumor suppository, or not the pelvic lymph node metastasis has a statistically significant effect on the recurrence of the cervical cancer. The effect of different treatments on the recurrence of cervical cancer was not statistically significant (P > 0.05). The multiple factor analysis showed that there was an independent factor in the recurrence of cervical cancer after operation, and the value of P was 0.004..
31 of the 2156 cases of cervical cancer died and the 5 year survival rate of the group was 80.13%. The single factor analysis showed that the 5 year survival rate (88.37%) of the early clinical stage group (< < I B2 stage) was significantly higher than the 5 year survival rate (70%) in the late stage group (> I B2). The difference was statistically significant (x 2=8.767, P=0.003), and the squamous cell carcinoma group was statistically significant. The 5 year survival rate (83.21%) was significantly higher than that of the adenocarcinoma and other pathological types (57.89%). The difference was statistically significant (x 2=12.078, P=0.001). The 5 year survival rate (87.14%) of the patients with superficial myometrium infiltration (87.14%) was significantly higher than that of the deep myometrium infiltration group (74.42%), the difference was statistically significant (x 2=4.172, P=0.041) The 5 year survival rate (84.85%) in the non vascular tumor thrombus group (84.85%) was significantly higher than the 5 year survival rate (54.17%) in the patients with vascular tumor thrombus group (54.17%), and the difference was statistically significant (x 2=13.824, P=0.000), and the 5 year survival rate (86.61%) in the patients without pelvic lymph node metastasis was significantly higher than that of the pelvic lymph node metastasis group (51.72%), and the difference was unified. The study significance (x 2=8.487, P=0.004), the age, the size of the primary tumor, the degree of tissue differentiation, and the effect of different treatments on the 5 year survival rate after cervical cancer were not statistically significant. The multivariate analysis showed that the clinical stage, the vascular tumor thrombus or the pelvic lymph node metastasis was an independent factor affecting the 5 year survival rate of cervical cancer. P values are 0.016,0.043 and 0.002., respectively.
Conclusion:
1 clinical staging, pathological type, or without vascular tumor thrombus, or without pelvic lymph node metastasis are the clinicopathological factors affecting the recurrence of uterine cancer after operation. There are no vascular tumor thrombus, which is an independent factor to determine the recurrence of cervical cancer after operation.
2 clinical staging, pathological type, depth of myometrium infiltration, vascular tumor suppository, or not pelvic lymph node metastasis are the clinicopathological factors that affect the 5 year survival rate of cervical cancer after operation. There are no vascular tumor thrombus or pelvic lymph node metastasis as an independent factor affecting the 5 year survival rate of cervical cancer after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
本文编号：2137137
[Abstract]:Objective: To explore the clinicopathological factors, clinical features and treatment methods of the recurrence and prognosis of cervical cancer after surgical treatment in our hospital, in order to reduce the recurrence of cervical cancer in our hospital, improve the survival rate and improve the prognosis of cervical cancer patients.
Methods: from January 1, 2007 to December 31, 2008, the gynecologic department of Fourth Hospital of Hebei Medical University was treated with surgical treatment. There were 156 cases of cervical cancer with pathological diagnosis, medical records and follow-up data (according to the 2009 staging of the International Union of Obstetrics and Gynecology). There were 22 cases of recurrence. The retrospective analysis was used to analyze the clinical records. Data, pathological data and follow-up data were all in accordance with the following criteria: (1) all patients were treated with radical hysterectomy (extensive hysterectomy plus pelvic lymphadenectomy) and cervical cancer confirmed by postoperative pathology; and (2) the diagnosis of recurrence: the diagnosis of recurrence mainly through the diagnosis of the disease, the biopsy and puncture of the tumor in the reappearance site. It was confirmed that the next clinical diagnosis of distant lung, bone metastasis can not be pathological diagnosis, can rely on symptoms, signs and auxiliary examination of the diagnosis of [2]; 3. Clinical records, pathological data complete, a relatively standardized, systematic follow-up data. All cases are followed by electric telephone follow up. Follow up after all treatment, follow all treatment, follow. The duration of the patient's survival time refers to the period of time from the day of the operation to the last follow-up or the death of the subject. The time of the patient's recurrence refers to the time from the day of the operation to the relapse of the subject. Age, clinical staging, primary tumor size, pathological type, degree of tissue differentiation, depth of myometrium infiltration, or without vascular tumor thrombus, pelvic lymph node metastasis, possible recurrence and prognostic factors such as different treatments were analyzed by single factor and (or) multivariate analysis. The SPSS13.0 software package was used for statistical analysis. The Kaplan-Meier method was used to calculate the survival rate, and to draw the corresponding survival curve, the survival rate and the recurrence related factors were compared with log-rank test, and the COX proportional risk regression model was used to analyze the factors of statistical significance (P0.05) in the single factor test for the recurrence and prognosis of the multifactorin analysis. The statistical analysis results were all P0.05 representative statistics. For patients who died of tumor factors during follow-up and at the last follow-up, they were still alive, and those who did not relapse were treated as truncated data.
Result:
22 of the 1156 patients with cervical cancer relapsed, and the recurrence rate of the whole group was 14.10%. single factor analysis. The recurrence rate of the early clinical stage group (9.30%) was significantly lower than that of the late clinical stage group (> I B2 stage). The recurrence rate was 20% (20%), and the difference was statistically significant (x 2=4.395, P=0.036), and the patients in the squamous cell carcinoma group had a relapse. The recurrence rate (12.23%) was significantly lower than that of the adenocarcinoma and other pathological types (29.41%), and the difference was statistically significant (x 2=5.409, P=0.020); the recurrence rate (10.61%) in the non vascular tumor thrombus group (10.61%) was significantly lower than that of the patients with vascular tumor thrombus group (33.33%), and the difference was statistically significant (x 2=13.824, P=0.000); no pelvic lymph node transfer was found. The recurrence rate of the group (11.02%) was significantly lower than that of the pelvic lymph node metastasis group (27.59%), and the difference was statistically significant (x 2=22.455, P=0.000), that is, the clinical stage, the pathological type, the vascular tumor suppository, or not the pelvic lymph node metastasis has a statistically significant effect on the recurrence of the cervical cancer. The effect of different treatments on the recurrence of cervical cancer was not statistically significant (P > 0.05). The multiple factor analysis showed that there was an independent factor in the recurrence of cervical cancer after operation, and the value of P was 0.004..
31 of the 2156 cases of cervical cancer died and the 5 year survival rate of the group was 80.13%. The single factor analysis showed that the 5 year survival rate (88.37%) of the early clinical stage group (< < I B2 stage) was significantly higher than the 5 year survival rate (70%) in the late stage group (> I B2). The difference was statistically significant (x 2=8.767, P=0.003), and the squamous cell carcinoma group was statistically significant. The 5 year survival rate (83.21%) was significantly higher than that of the adenocarcinoma and other pathological types (57.89%). The difference was statistically significant (x 2=12.078, P=0.001). The 5 year survival rate (87.14%) of the patients with superficial myometrium infiltration (87.14%) was significantly higher than that of the deep myometrium infiltration group (74.42%), the difference was statistically significant (x 2=4.172, P=0.041) The 5 year survival rate (84.85%) in the non vascular tumor thrombus group (84.85%) was significantly higher than the 5 year survival rate (54.17%) in the patients with vascular tumor thrombus group (54.17%), and the difference was statistically significant (x 2=13.824, P=0.000), and the 5 year survival rate (86.61%) in the patients without pelvic lymph node metastasis was significantly higher than that of the pelvic lymph node metastasis group (51.72%), and the difference was unified. The study significance (x 2=8.487, P=0.004), the age, the size of the primary tumor, the degree of tissue differentiation, and the effect of different treatments on the 5 year survival rate after cervical cancer were not statistically significant. The multivariate analysis showed that the clinical stage, the vascular tumor thrombus or the pelvic lymph node metastasis was an independent factor affecting the 5 year survival rate of cervical cancer. P values are 0.016,0.043 and 0.002., respectively.
Conclusion:
1 clinical staging, pathological type, or without vascular tumor thrombus, or without pelvic lymph node metastasis are the clinicopathological factors affecting the recurrence of uterine cancer after operation. There are no vascular tumor thrombus, which is an independent factor to determine the recurrence of cervical cancer after operation.
2 clinical staging, pathological type, depth of myometrium infiltration, vascular tumor suppository, or not pelvic lymph node metastasis are the clinicopathological factors that affect the 5 year survival rate of cervical cancer after operation. There are no vascular tumor thrombus or pelvic lymph node metastasis as an independent factor affecting the 5 year survival rate of cervical cancer after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
【引证文献】
相关期刊论文 前2条
1 郭玉萍;那仁花;古丽娜·库尔班;;淋巴结阳性率在ⅠB～ⅡA期宫颈癌患者中的临床意义[J];现代妇产科进展;2016年09期
2 黄莉莎;;1例宫颈癌术后复发大出血合并凝血障碍及高血糖病人的急救与护理[J];全科护理;2016年05期
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