论文部分内容阅读
目的宫颈癌FIGO分期存在一定的缺陷,血浆D-二聚体(D-D)水平与肿瘤预后密切相关。本研究探讨术前血浆D-D水平对早期宫颈癌术后复发的影响。方法试验设计属于前瞻性随访研究,以2009-01-01-2012-12-31广州市花都区妇幼保健院诊治的165例早期宫颈癌患者为研究对象。根据术前血浆D-D水平分为D-D升高组和D-D正常组,以电话随访为主,随访终点事件为宫颈癌复发。生存率估算应用Kaplan-Meier法,组间生存率曲线差异采用Log-rank检验,应用多变量Cox比例风险回归分析宫颈癌复发的独立危险因素。结果 D-D升高组67例(40.6%)。D-D正常组和D-D升高组中肿瘤直径≥4cm的比例分别为15.3%和29.9%,χ~2=5.037,P=0.025;淋巴结转移分别为35.7%和55.2%,χ~2=6.158,P=0.013;临床分期Ⅰ/ⅡA分别为47/51和20/47,χ~2=5.411,P=0.020。D-D正常组有11例复发,复发时间中位数为36(15~62)个月,5年无复发生存率为88.8%;D-D升高组有16例复发,复发时间中位数为25.5(6~50)个月,5年无复发生存率为74.0%。Kaplan-Meier生存曲线表明,D-D升高组无复发生存率显著低于D-D正常组,χ~2=4.805,P=0.028。单因素分析显示,组织学类型(HR=1.124,P=0.034)、淋巴结转移(HR=1.589,P=0.016)、FIGO分期(HR=1.854,P=0.007)、D-D水平(HR=1.395,P=0.023)和治疗方法(HR=0.891,P=0.043)为复发的危险因素。多变量Cox比例风险回归分析显示,淋巴结转移(HR=2.116,P=0.012)、FIGO分期(HR=4.421,P=0.001)、D-D水平(HR=2.125,P=0.039)和治疗方法(HR=0.912,P=0.045)是影响宫颈癌复发的独立危险因素。结论术前D-D水平是影响宫颈癌复发的危险因素,有助于更好地指导治疗、判断预后。
Purpose There is a certain defect in the FIGO staging of cervical cancer. The level of plasma D-dimer (D-D) is closely related to tumor prognosis. This study was to investigate the effect of preoperative plasma D-D on the recurrence of early cervical cancer. Methods The trial design was a prospective follow-up study of 165 early cervical cancer patients diagnosed and treated in Huadu District Guangzhou Maternal and Child Health Hospital from January 2009 to January 12, 2012. According to the preoperative plasma D-D levels were divided into D-D elevated group and D-D normal group, mainly by telephone follow-up, end-follow-up event for cervical cancer recurrence. Kaplan-Meier method was used to estimate the survival rate. Log-rank test was used to evaluate the difference of survival rate between groups. Multivariate Cox proportional hazards regression was used to analyze the independent risk factors of cervical cancer recurrence. Results D-D elevated group of 67 cases (40.6%). The ratio of tumor diameter≥4cm in DD normal group and DD elevated group were 15.3% and 29.9%, respectively, χ ~ 2 = 5.037, P = 0.025; lymph node metastasis was 35.7% and 55.2%, respectively, χ ~ 2 = = 0.013; clinical stage I / IIA were 47/51 and 20/47, respectively, χ ~ 2 = 5.411, P = 0.020. DD normal group, 11 cases of recurrence, the median recurrence time was 36 (15 ~ 62) months, 5-year recurrence-free survival rate was 88.8%; DD elevated group of 16 patients relapsed with a median recurrence time of 25.5 ( 6 ~ 50) months, 5-year recurrence-free survival rate was 74.0%. Kaplan-Meier survival curves showed that the recurrence-free survival of D-D increased group was significantly lower than that of D-D normal group (χ ~ 2 = 4.805, P = 0.028). Univariate analysis showed that histological type (HR = 1.124, P = 0.034), lymph node metastasis (HR = 1.589, P = 0.016), FIGO staging (HR = 1.854, P = 0.007) = 0.023) and treatment (HR = 0.891, P = 0.043) were risk factors for relapse. Multivariate Cox proportional hazards regression analysis showed that lymph node metastasis (FIG. 2), FIGO staging (HR = 4.421, P = 0.001), DD level (HR = 2.125, P = 0.039) and treatment (HR = 0.912, P = 0.045) were independent risk factors for cervical cancer recurrence. Conclusions Preoperative D-D level is a risk factor for cervical cancer recurrence, which helps to better guide the treatment and prognosis.