宫颈鳞癌预后因素的层别化及其临床意义  

Stratification of Prognostic Factors for Squamous Cell Carcinoma of the Cervix and Its Clinical Significance

作　　者：熊樱[1] 梁立治[1] 刘继红[1] 彭小萍[1] 魏梅[1] 沈扬[1] 李孟达[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心妇科,广州市510060

出　　处：《中国肿瘤临床》2007年第18期1048-1052,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨影响宫颈鳞癌预后的因素,将其按预后风险水平层别化,并建立预后预测系统以指导个体化治疗方案。方法:对287例FIGOⅠb1～Ⅱb期宫颈鳞癌的临床病理资料和随访结果进行分析,通过单因素和多因素分析筛选并层别化预后影响因素。结果:287例患者5年无瘤生存率为81.3%。多重COX回归分析显示,影响预后的独立因素为盆腔淋巴结转移(P<0.001)和宫旁切缘阳性(P=0.013)(A级因素)、宫颈深肌层浸润(P=0.035)(B级因素)。具有A级因素者局部复发率、局部伴远处转移率和远处转移率分别为27.4%、4.1%和13.7%;具有B级因素者局部复发率为20.0%,局部伴远处转移率为1.1%,远处转移率为1.1%;无A级或B级因素者局部复发率为9.2%,局部伴远处转移率为1.7%,远处转移率为0.8%。根据A级和B级因素建立预后预测系统,高危组患者具有A级因素,5年无瘤生存率为25.0%～61.3%;中危组患者无A级因素但具有B级因素,5年无瘤生存率为83.7%;低危组患者无A级或B级因素,5年无瘤生存率为93.9%。结论:盆腔淋巴结转移、宫旁切缘阳性、宫颈深肌层浸润为影响宫颈鳞癌预后的因素。具有上述不同因素的患者预后风险及复发模式有所不同,有必要采取个体化的治疗来提高远期疗效。Objective： To investigate and stratify the prognostic factors of cervical squamous cell carcinoma according to the corresponding prognostic risks and to establish a prognosis-predictive system. Methods： The clinicopathological data and follow-up results of 287 cases of cervical squamous cell carcinoma were analyzed. The prognostic factors were identified and stratified by univariate and multivariate analysis. Results： The 5-year disease-free survival （DFS） rate was 81.3% for the 287 cases. Multiple Cox regression analysis identified pelvic node metastasis （P〈0.001）, positive parametrial surgical margin （P=0.013） （class A factors） and deep stromal invasion （P=0.035） （class B factor） as prognostic factors. Local recurrence, local recurrence plus distant metastasis and distant metastasis were seen in 27.4%, 4.1% and 13.7% of patients with class A factor（s）, 20.0%, 1.1% and 1.1% of those with class B factors, and 9.2%, 1.7% and 0.8% of the patients with neither class A nor class B factors, respectively. A prognosis-predictive system based on class A and class B factors was established. Patients with class A factor（s） were divided into the high risk group with 5-year DFS rate ranging from 25.0% to 61.3%, patients with class B factors were in the intermediate risk group with a DFS rate of 83.7%, while patients with neither A nor B factors were in the low risk group with a DFS rate of 93.9%. Conclusion： Pelvic node metastasis, positive parametrial surgical margin, and deep stromal invasion are factors that influence the prognosis of squamous cell carcinoma of the cervix. Patients with the above factors have various levels of prognostic risk and different patterns of recurrence, therefore individualized treatment should be considered.

关 键 词：宫颈肿瘤 复发 预后 

分 类 号：R737.33[医药卫生—肿瘤]