206例IB期宫颈鳞癌患者手术＋放疗的预后分析  

The prognostic factors for patients with stage IB cervical squamous cell carcinoma treated by radical hysterectomy and radiotherapy

作　　者：王晔[1] 张蓉[1] 吴令英[1] 白萍[1] 李晓光[1] 李洪君[1] 马绍康[1] 李淑敏[1] 李斌[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所妇瘤科,北京100021

出　　处：《中华放射肿瘤学杂志》2010年第3期241-245,共5页Chinese Journal of Radiation Oncology

摘　　要：目的 探讨Ⅰb期手术治疗宫颈鳞癌患者的无瘤生存时间和预后因素.方法 回顾分析2006年前7年本院行PivermⅢ型颈癌根治术＋盆腔淋巴结清扫术的206例Ⅰb期宫颈鳞癌患者资料.其中ⅠB1期103例,ⅠB2期103例;术前放疗79例,术后辅助治疗111例.生存率用Kaplan-Meier法计算并Logrank检验和单因素预后分析,Cox模型进行预后多因素分析.结果 随访率为92.7%,随访满5年者106例.全组5年无瘤生存率和总生存率分别为86.8%和96.3%,ⅠB1、ⅠB2期的分别为94.6%和100%、77.9%和92.2%.单因素分析显示肿瘤大/b（FIGO分期）、脉管瘤栓、穹窿以下阴道受累、宫旁阳性和淋巴结转移数〉2个对Ⅰb期5年无瘤生存率有影响,分别为77.9%：94.6%（χ^2=5.58,P=0.018）、74.6%：89.8%（χ^2=10.44,P=0.001）、50%：87.9%（χ^2=7.01,P=0.008）、63.5%：89.5%（χ^2=17.69,P=0.000）和43.6%：89.4%（χ^2=21.47,P=0.000）.多因素分析显示HGO分期、脉管瘤栓、淋巴结转移数〉2个对全组5年无瘤生存率有影响（χ^2=4.73,P=0.030;χ^2=9.81,P=0.002;χ^2=6.30,P=0.012）;脉管瘤栓、淋巴结转移数〉2个对ⅠB2期5年无瘤生存率有影响（χ^2=6.38,P=0.012;χ^2=3.92,P=0.048）.结论 对宫颈鳞癌,脉管瘤栓是ⅠB1期无瘤生存的重要预测指标.术后放疗能减少ⅠB2期复发,但不提高总生存.ⅠB2期术后必须辅助放疗者,术前放疗只用于提高手术成功率,对无瘤生存无影响.ⅠB1期术后只有深肌层浸润者,宜减少术后补充放疗.Objective To analyze the disease-free survival （DFS） and prognostic factors for stage IB cervical squamous cell carcinoma treated by radical hysterectomy. Methods From January 1999 to December 2005, a total of 206 patients with uterus cervical squamous cell carcinoma were retrospectively analyzed. All the patients were treated by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Cancer Hospital, Chinese Academy of Medical Sciences. The diseases were stage I B1 and I B2 in 103 patients each. Seventy-nine （76.7%） patients had preoperative radiotherapy and 111 （53. 9% ） had postoperative adjuvant treatment （PosAT）. Prognostic factors were analyzed using univariate model and multivariate Cox model. Results The follow-up rate was 92. 7%. 106 patients had following-up time of five years. The overall 5-year survival rate and the disease-free survival rate of stage Is, Is, and IB2 were 96. 3% and 86. 8%, 100% and 94. 6%, 92. 2% and 77.9%, respectively. Univariate predictors of DFS included tumor size （ FIGO stage, 77.9% ： 94. 6% ; χ^2 = 5.58, P = 0. 018 ）, lympho-vascular space involvement （ LVSI, 74.6% ： 89. 8% ; χ^2 = 10.44, P = 0. 001 ）, vaginal involvement （ purely fornix involvement was not included disease, 50% ： 87.9% ; X2 = 7. 01, P = 0. 008 ） , parametrial involvement （ PI, χ^2 = 17.69 ,P = 0. 000 ）, and metastatic lymph nodes （ LNM ） 〉 2 （ χ^2= 21.47, P = 0. 000 ） in stage IB disease, while LVSI （ χ^2 = 6. 35, P = 0. 012）, PI （χ^2 = 90. 00,P = 0. 000） and LNM 〉 2 （ χ^2 = 26.27, P = 0. 000） in stage IB1 disease, LVSI （ χ^2= 10. 12, P = 0. 001 ）, cervical canal involvement （ χ^2 = 4. 60, P = 0. 032）, vaginal involvement （ χ^2 = 5.87, P = 0. 015 ）, PI （ χ^2= 4. 78, P = 0. 029 ） and LNM 〉 2 （ χ^2 = 6. 72,P=0. 010） in stage IB2 disease. In multivariate analysis, FIGO stage （χ^2 =4. 73,P =0. 030）, LVSI （ χ^2 = 9. 81, P = 0. 002 ）, and LNM 〉 2 （χ^2 = 6. 30, P = 0. 012 ） were significantl

关 键 词：宫颈肿瘤/外科学 宫颈肿瘤/放射疗法 预后 

分 类 号：R686[医药卫生—骨科学]