106例Ⅰa～Ⅱb期宫颈癌肺转移患者的临床特点和预后影响因素  

Clinical analysis and prognostic factors in 106 patients with stage Ⅰa-Ⅱ b cervical cancer with pulmonary metastasis

作　　者：舒桐[1] 白萍[1] 张蓉[1] 李淑敏[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院妇瘤科,100021

出　　处：《中华肿瘤杂志》2014年第9期703-707,共5页Chinese Journal of Oncology

摘　　要：目的 探讨Ⅰa～Ⅱb期宫颈癌肺转移患者的临床特点及预后影响因素.方法 收集中国医学科学院肿瘤医院1999年1月至2013年6月收治的106例Ⅰa～Ⅱb期宫颈癌肺转移患者的临床资料,分析肺转移不同治疗方式的疗效差异及预后影响因素.结果 106例患者中,有89例（83.9％）患者肺转移发生在宫颈癌治疗后2年内.106例患者的中位无瘤生存间期为13个月,宫颈癌肺转移后的中位生存时间为18个月,2年和5年生存率分别为37.7％和7.5％.肺转移灶多分布于右肺下叶.手术可使单、双侧肺转移均达到临床有效,非手术治疗临床有效率为60.2％.单因素分析显示,宫颈癌的病理类型、分化程度、肺转移范围以及是否同时伴有其他部位转移与宫颈癌肺转移患者的预后有关.多因素分析显示,宫颈癌的分化程度是影响宫颈癌肺转移患者预后的独立因素.结论 建议对Ⅰa～Ⅱb期宫颈癌患者采用胸部CT定期随访.手术与非手术治疗肺部转移灶均为可行的治疗手段,但需严格把握手术的适应证.肿瘤细胞分化差的Ⅰa～ Ⅱb期宫颈癌发生肺转移后预后较差.Objective To investigate the clinical characteristics and prognostic factors for patients with stage Ⅰa-Ⅱ b cervical cancer with pulmonary metastasis （CCMP）.Methods Clinical information of 106 patients with stage Ⅰa-Ⅱb cervical cancer with lung metastases admitted in the Chinese Academy of Medical Sciences Cancer Hospital from January 1999 to June 2013 was collected.The efficacy of different therapeutic methods for lung metastases was compared and relevant prognostic factors were analyzed.Results Pulmonary metastases were detected in 89 （83.9%） out of a total of 106 patients within 2 years after initial treatment of cervical cancer.The median disease-free interval （DFI） of the 106 patients was 13 months.The median survival after CCMP was 18 months,with 2-year and 5-year survival rates of 37.7% and 7.5%,respectively.Metastases were mainly distributed in the inferior lobe of right lung.The surgical treatment was proven to be clinically effective in both unilateral and bilateral CCMP.The response rate was 60.2% in patients choosing non-operative treatment.The univariate analysis showed that pathological type of cervix carcinoma,low degree of differentiation,scope of pulmonary metastasis and whether CCMP simultaneously accompanied with other parts of recurrence were closely related to the prognosis,while the differentiation of cervical tumor was an independent prognostic factor drawn from multivariate regression analysis.Conclusions Regular CT lung screening is recommended for patients with stage Ⅰ a-Ⅱ b cervical cancer during their follow-up period.Both operative and non-operative treatments are feasible therapeutic methods for CCMP.But surgical resection is strictly restricted to certain operative indications.Ⅰ a-Ⅱ b stage cervical cancer of low differentiation has poorer prognosis after lung metastasis.

关 键 词：宫颈肿瘤 肿瘤转移 肺 诊断 治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]