论文部分内容阅读
目的分析子宫颈鳞癌Ⅰb~Ⅱa期患者的预后影响因素并建立预后预测系统,以探讨其在指导术后辅助治疗中的作用。方法回顾性分析接受手术治疗的306例Ⅰb~Ⅱa期宫颈鳞癌患者的临床病理资料,对影响其预后的因素进行单因素和多因素分析。结果306例患者的5年生存率为78 1%。单因素分析结果显示,与其预后有关的因素为淋巴结转移、病理分化程度、肿瘤直径、宫旁组织浸润、深肌层浸润和脉管内瘤栓(P<0 05);多因素分析结果显示,淋巴结转移、深肌层浸润、宫旁组织浸润是影响其预后的独立危险因素(P<0 05)。根据危险因素的不同建立预后预测系统,即将患者分为低危组、中危组和高危组3组,其5年生存率分别为90 3%、83 9%和43 1%。低危组(无危险因素或仅宫旁组织浸润)局部复发的发生率仅为2 2%;中危组(深肌层浸润或合并有宫旁组织浸润)局部复发的发生率为13 5%,远处转移的发生率为1 3%, 局部复发合并远处转移的发生率为0 6%;高危组(淋巴结转移或合并其他危险因素)局部复发和远处转移的发生率分别为25 9%和48 3%,局部复发合并远处转移的发生率为10 3%。结论淋巴结转移、深肌层浸润、宫旁组织浸润是影响Ⅰb~Ⅱa期宫颈鳞癌患者预后的独立因素;根据预后影响因素建立的预后预测系统有助于指导术后辅助治疗。
Objective To analyze prognostic factors of patients with stage Ⅰb ~ Ⅱa cervical squamous cell carcinoma and to establish a prognostic prediction system to explore its role in guiding the postoperative adjuvant therapy. Methods The clinical and pathological data of 306 patients with stage Ⅰb-Ⅱa cervical squamous cell carcinoma who underwent surgery were retrospectively analyzed. Univariate and multivariate analyzes were carried out on the factors influencing their prognosis. Results The 5-year survival rate of 306 patients was 78.1%. Univariate analysis showed that the prognostic factors were lymph node metastasis, pathological differentiation, tumor diameter, paracancerous tissue infiltration, deep myometrial invasion and vascular emboli (P <0.05). Multivariate analysis showed that lymph nodes Metastasis, deep myometrial invasion, parametrial infiltration was an independent risk factor for prognosis (P <0.05). According to the different risk factors, the prognosis prediction system was established. The patients were divided into low risk group, moderate risk group and high risk group. The 5-year survival rates were 90.3%, 83.9% and 43.1% respectively. The incidence of local recurrence was only 22% in the low-risk group (no risk factors or paracarcinoma infiltration only). The incidence of local recurrence in the intermediate-risk group (deep myometrial invasion or paracarcinomatous infiltration) was 135% , The incidence of distant metastasis was 13%, the incidence of local recurrence with distant metastasis was 0.6%; the incidence of local recurrence and distant metastasis in high-risk group (lymph node metastasis or other risk factors) were 25 9 % And 48.3% respectively. The incidence of local recurrence combined with distant metastasis was 103%. Conclusions Lymph node metastasis, deep myometrial invasion and parametrial invasion are independent prognostic factors for patients with stage Ⅰb-Ⅱa cervical squamous cell carcinoma. Prognostic prediction system based on prognostic factors may be helpful in guiding postoperative adjuvant therapy.