FIGO 2018子宫颈癌新分期ⅠB期各亚分期设置的合理性探讨  

Rationality of stage ⅠB substaging in FIGO 2018 new staging of cervical cancer

作　　者：曹玉叶 黎志强[1] 郝敏[2] 刘萍[1] 崔竹梅[3] 康山 王莉[5] 赵卫东[6] 詹雪梅[7] 陈必良 纪妹[9] 李维丽[1] 宾晓农 陈春林[1] 郎景和 CAO Yu-ye;LI Zhi-qiang;HAO Min;LIU Ping;CUI Zhu-mei;KANG Shan;WANG Li;ZHAO Weidong;ZHAN Xue-mei;CHEN Bi-liang;JI Mei;LI Wei-li;BIN Xiao-nong;CHEN Chun-lin;LANG Jing-he(Department of Obstetrics and Gynecology,Nanfang Hospitdl,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]山西医科大学附属第二医院妇产科,山西太原030001 [3]青岛大学附属医院妇产科,山东靑岛266000 [4]河北医科大学第四医院妇科,河北石家庄050000 [5]河南省肿瘤医院妇科,河南郑州450008 [6]中国科学技术大学附属第一医院(安徽省立医院),安徽合肥230001 [7]江门市中心医院,广东江门529030 [8]空军军医大学西京医院妇科,陕西西安710032 [9]郑州大学第一附属医院妇产科,河南郑州450052 [10]广州医科大学公共卫生学院,广东广州511436 [11]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2021年第4期468-473,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);国家自然科学基金(81272585);广州市科技计划(158100075);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD019)。

摘　　要：目的探讨FIGO 2018子宫颈癌新分期ⅠB期各亚分期设置的合理性。方法基于中国子宫颈癌临床诊疗项目数据库,对47家医院于2004-2018年间收治的原FIGO 2009ⅠB期子宫颈癌以开腹手术为初始治疗的9130例患者,按照FIGO 2018分期标准重新分期。设原FIGO 2009分期ⅠB期中淋巴结阳性病例为ⅢC-ⅠB期,比较FIGO 2018ⅠB1/ⅠB2/ⅠB3/ⅢC-ⅠB期患者的肿瘤学结局。结果(1)纳入符合入组标准的原FIGO 2009ⅠB期病例9130例,按FIGO 2018分期标准重新分期,ⅠB1、ⅠB2、ⅠB3期分别为1954例、3255例和1506例,ⅢC-ⅠB期1509例,无法明确分期906例。(2)单因素分析得出,ⅠB1期肿瘤学结局优于ⅠB2期[5年总体生存率(overall survival,OS):97.8%vs.94.5%,P<0.001;5年无瘤生存率(disease-free survival,DFS):94.6%vs.90.7%,P<0.001];ⅠB2期5年OS优于ⅠB3期(94.5%vs.93.0%,P=0.019),但两组5年DFS差异无统计学意义(90.7%vs.89.4%,P=0.116);ⅠB期各亚分期的肿瘤学结局均优于ⅢC-ⅠB期。(3)多因素分析得出,分期越晚是影响子宫颈癌患者死亡及复发/死亡的独立危险因素。结论从子宫颈癌开腹手术治疗肿瘤学结局的角度分析,FIGO 2018子宫颈癌新分期ⅠB期各亚分期设置合理。To explore the rationality of FIGO 2018 new stageⅠB of cervical cancer.MethodsBased on the large database of the clinical diagnosis and treatmentfor cervical cancer in China,9130 patients withⅠB stage(FIGO 2009) cervical cancer treated initially bylaparotomy in 47 hospitals from 2004 to 2019 wererestaged according to FIGO 2018 staging standard.Thepatients with positive lymph nodes in stageⅠB of FIGOin 2009 were redefined as stage ⅢC-ⅠB,and thencompare the oncological outcomes of patients with FIGO2018 ⅠB1/ⅠB2/ⅠB3/ⅢC-ⅠB.Results(1)Totally9130 patients with original FIGO 2009 ⅠB stage wereincluded,and were redivided according to the FIGO 2018 staging standard,1954,3255 and 1506 patients wereincluded in the stageⅠB1,ⅠB2 andⅠB3,respectively,and 1509 patients in stage ⅢC-ⅠB,and 906 cases couldnot be classified.(2)Univariate analysis showed that theoncological outcome of stageⅠB1 was better than that of stageⅠB2(5-year OS:97.8% vs. 94.5%,P< 0.001;5-year DFS:94.6% vs. 90.7%,P<0.001);the 5-year OS ofⅠB2 was better than that of stageⅠB3(94.5% vs. 93.0%,P=0.019),but there was no significant difference in 5-year DFSbetween the two groups(90.7% vs. 89.4%,P=0.116);the oncological outcome of eachⅠB sub-stage was better than thatof stage ⅢC-ⅠB(.3)Multivariate analysis showed that more advanced tumor stage was the independent risk factor fordeath and relapse/death of patients with cervical cancer.ConclusionFrom the perspective of oncology outcome ofabdominal surgery for cervical cancer,the substages of FIGO 2018 new stageⅠB of cervical cancer is reasonable.

关 键 词：子宫颈肿瘤 FIGO 2018 肿瘤学结局 

分 类 号：K737.3[历史地理—历史学]