宫颈残端癌53例临床特征及预后分析  

Analysis of Prognosis and Clinical Characteristics of 53 Cases of Stump Cervical Cancer

作　　者：赵婷婷[1,2] 王晶[1] 于丽波[1] 李文乐[1] 王春辉[1] 陈慧[1] 

机构地区：[1]哈尔滨医科大学附属第三临床医院,黑龙江哈尔滨150000 [2]长江大学附属第一医院荆州市第一人民医院,湖北荆州434000

出　　处：《实用妇产科杂志》2012年第11期977-980,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨宫颈残端癌的临床特征及影响预后的因素,为临床诊治提供参考。方法:收集53例宫颈残端癌患者的临床资料进行回顾性分析,用卡方检验、Kaplan-Meier法、Log-rank检验和COX回归模型进行统计学分析。结果:中位发病年龄为46岁,24例(45.28%)表现为阴道不规则流血。ⅠA1～ⅠB1、ⅡA1期18例中15例行根治性宫颈切除术+盆腔淋巴结切除术;ⅠB2、ⅡA2、ⅡB期13例中10例新辅助化疗后,行根治性宫颈切除术+盆腔淋巴结切除术;ⅢA～ⅣB期22例中14例行放疗同步化疗,其余行单纯化疗或放疗。术后有高危因素的患者中18例补充放疗和(或)化疗。中位生存时间为45.9个月,5年生存率为53.2%。多因素分析显示FIGO临床分期(P=0.042)、组织学分级(P=0.034)、脉管瘤栓(P=0.038)是影响预后的独立危险因素。肿瘤直径大小及组织学分级与脉管瘤栓发生有关。结论:宫颈残端癌临床表现主要为阴道不规则流血,治疗以手术和放疗为主,但预后较差。FIGO临床分期高(ⅡB～Ⅳ期)、组织学分级低分化、有脉管瘤栓是影响预后的因素。Objective： To analyze the clinical pathological characteristics and prognostic factors of the stump cervical cancer. Methods： Clinical data of 53 cases of stump cervical cancer were retrospectively ana- lyzed using Chi-square test, Kaplan-Meier analysis, log-rank test, and COX regression model. Results：The median age of onset was 46 years, and the common clinical manifestation was irregular vaginal bleeding （24 cases,45.28% ）. Treatment for patients in ⅠA1-Ⅰ B1 and Ⅱ A1 stages was radical trachelectomy plus pel- vic lymph node dissection. Treatment for patients in Ⅰ B2, Ⅱ A2 and ⅡB stages was neoadjuvant chemothera- py followed by radical trachelectomy plus pelvic lymph node dissection. Those patients without significant im- provement after neoadjuvant chemotherapy could be switched to radiotherapy. Treatment for patients in Ⅲ A- Ⅲ B stages was radiation synchronous chemotherapy. 18 patients with the risk factors, includingtumor di- ameter 〉 4 cm, lymph node metastasis and low histological stage,were added the postsurgical radiation and （or） chemotherapy. The median overall survival was 45.9 months, and the 5-year overall survival rate was 53.2%. Multivariate analysis showed that FIGO stage （ P = 0. 042 ）, histological differentiation （ P = 0. 034 ）, and vascular tumor thrombus（ P = 0. 038）were independent prognostic factors. Vascular tumor thrombus was correlated to tumor size and histological differentiation. Conclusions：The main treatments for stump cervical cancerwere surgery and radiotherapy. Radical surgery would improve the overall survival. FIGO clinical stage,histological differentiation, and vascular tumor thrombus were independent prognostic risk factors for cervical stump cancer. Vascular tumor thrombus was correlated to tumor size and histological differentiation.

关 键 词：宫颈残端癌 宫颈癌 预后因素 

分 类 号：R737.33[医药卫生—肿瘤]