60例宫颈残端癌预后因素分析  

Analysis of Comprehensive Treatment and Prognostic Factors for Patients with Cervical Stump Carcinoma

作　　者：陈鲁[1] 夏婷[1] 羊正炎[1] 朱笕青[1] 

机构地区：[1]浙江省肿瘤医院妇瘤科,杭州市310022

出　　处：《中国肿瘤临床》2009年第8期192-194,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:初步评估综合治疗对宫颈残端癌治疗及预后判断的价值。方法:回顾性分析2000年1月至2007年12月浙江省肿瘤医院收治的宫颈残端癌60例临床病例资料,对影响其预后的因素进行单因素分析,独立性预后因素经COX风险比例模型分析判断。结果:60例患者的1年,3年和5年生存率分别为95%,78%和68%,中位生存期32个月。单因素分析结果显示:淋巴结转移(P=0.001),脉管瘤栓(P=0.001)和辅助化疗(P=0.011)分别是独立的生存预后因素。盆腔局部复发1例和远处转移3例。发生放射性膀胱炎,阴道直肠瘘,膀胱阴道瘘并发症等共6例(10%)。治疗前后分别检测血清鳞状上皮抗原比较结果显示统计学差异(P=0.000)。结论:宫颈残端癌发病率低,但治疗难度大、并发症发生率高、远处转移多见,因而需要个体化的治疗。应严格掌握好子宫次全切除术的适应证和加强子宫次全切除术后的严密随访观察。Objective： To evaluate the value of comprehensive treatment and prognostic factors for patients with cervical stump carcinoma. Methods： The clinical data of 60 patients with cervical stump carcinoma who underwent comprehensive treatment between January 2000 and December 2007 were retrospectively analyzed. The prognostic factors were explored using univariate method. Independent prognostic factors were identified by Cox proportional hazards regression model. Results： The 1-, 3- and 5-year survival rates of these 60 patients were 95%, 78%, and 68%, respectively. Median survival was 32 months. Univariate survival analysis showed that positive pelvic lymph nodes （P=0.001）, lymph-vascular space involvement （P=0.001） and adjuvant chemotherapy （P=0.011） were independent prognostic factors. One case had pelvic recurrence, 3 cases had distant metastasis, and 6 cases had complications including radioactive cystitis, vaginorecta fistula and vesicovaginal fistula. Serum squamous cell carcinoma antigen levels were significantly different before and after treatment （P=0.000）. Conclusion： The incidence of cervical stump carcinoma is low and the disease is difficult to treat. Complications and distant metastasis are common. Treatment should be individualized. Indications for subtotal hysterectomy should be strictly evaluated.

关 键 词：宫颈残端 肿瘤 治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]