摘要
目的探讨影响临床早期宫颈腺癌预后的相关因素,并分析不同辅助治疗方法对预后的影响。方法回顾性分析自1995年11月至2012年2月间于北京协和医院治疗的118例FIGOⅠa2期-Ⅱa2期宫颈腺癌患者的临床资料,记录人口统计学信息、诊断及治疗信息,并记录随访及生存资料,采用SPSS11.5软件Cox回归分析进行肿瘤复发相关因素分析。结果 118例患者的中位年龄为41岁(19～74岁),其中有102例(86.4%)初次治疗时采取了根治性子宫切除和/或双附件切除和/或盆腔腹主动脉旁淋巴结切除术。平均随诊29.8月(2～132月),19例患者在随访过程中肿瘤复发,7例患者死亡。与肿瘤复发相关的单因素分析显示,患者年龄大(P=0.008)、期别晚(P=0.008)、肿瘤≥4 cm(P=0.006)、淋巴结阳性(P=0.001)、宫颈有深肌层浸润(P=0.016)均是复发的高危因素,而淋巴血管间隙浸润及腺癌的病理类型与复发无明显相关性。多因素分析显示,仅淋巴结转移是肿瘤复发的独立高危因素(P=0.006)。淋巴结阴性和阳性患者的5年无瘤生存率分别为79.1%和12.7%,5年总生存率分别为94.0%和40.0%。淋巴结转移与肿瘤≥4 cm(P=0.018)、宫颈深肌层浸润(P=0.001)显著相关,而与年龄(P=0.746)、FIGO分期(P=0.155)、淋巴血管间隙浸润(P=0.802)不相关。对于高危患者,手术后辅助放化疗可延长患者无瘤生存期,但未达到统计学意义(P=0.201)。结论宫颈腺癌预后较差,早期患者的独立预后因素是盆腔淋巴结转移,对于高危患者于根治性子宫切除术后进行辅助放化疗可能延缓肿瘤复发。
Objective To evaluate the relative risk factors and impact of adjuvant treatment on the disease recurrence of early-stage cervical adenocarcinoma. Methods One hundred and eighteen FIGO Ia2-IIa2 patients diagnosed with cervical adenocarcinoma were treated at Peking Union Medical College Hospital （PUMCH） from Nov, 1995 to Feb, 2012. The demographic, treatment and survival information were retrospectively reviewed. Follow-up and survival data was also collected. Data were analyzed using Cox proportional hazards regression. Results The mean age of the patients was 41 years （19-74years）. 102 of 118 patients （86.4%） were given radical hysterectomy and/or bilateral salpingo-oophorectomy （BSO） and/or lymphadenectomy during the primary treatment. With the mean follow-up time 29.8 months （2-132months）, 19 patients developed disease recurrence and 7 patients died of the disease. In the univariate analysis, old age （p=0.008）, late-stage disease （p=0.008）, large tumor （p=0.006） , pelvic nodal metastasis （p=0.001） and deep stromal invasion（p=0.016）were related to tumor recurrence. While in the multivariate analysis, pelvic nodal metastasis was the only independent risk factor. For the patient with high-risk factors, chemoradiation after radical hysterectomy could prolong the disease free survival but have no statistical significance （P = 0.201）. Conclusion Adenocarcinoma is a kind of poor survival cervical cancer in early-stage patients. Pelvic nodal metastasis is the independent risk factor. Adjuvant chemoradiation after radical hysterectomy may prolong the disease free survival in patients with high-risk factors.
出处
《基础医学与临床》
CSCD
北大核心
2013年第3期257-263,共7页
Basic and Clinical Medicine
关键词
子宫颈癌
腺癌
治疗
预后
cervical carcinoma
adenocarcinoma
therapy
prognosis
