FIGO 2018子宫颈癌分期Ⅲ期各亚期设置合理性探讨  

Rationality of stageⅢsubstaging in FIGO 2018 staging of cervical cancer

作　　者：刘萍[1] 黎志强[1] 柳攀 赵宏伟[2] 郝敏[3] 崔竹梅[4] 林丽红[5] 康山 杨清[7] 倪妍 赵卫东[9] 刘畅[10] 王武亮[11] 宾晓农 郎景和 陈春林[1] LIU Ping;LI Zhi-qiang;LIU Pan;ZHAO Hong-wei;HAO Min;CUI Zhu-mei;LIN Li-hong;KANG Shan;YANG Qing;NI Yan;ZHAO Wei-dong;LIU Chang;WANG Wu-liang;BIN Xiao-nong;LANG Jing-he;CHEN Chun-lin(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;不详)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]山西省肿瘤医院妇科,山西太原030001 [3]山西医科大学附属第二医院妇产科,山西太原030001 [4]青岛大学附属医院妇产科,山东青岛266000 [5]安阳市肿瘤医院妇科,河南安阳455000 [6]河北医科大学第四医院妇科,河北石家庄050000 [7]中国医科大学附属盛京医院妇产科,辽宁沈阳110004 [8]太原市中心医院妇产科,山西太原044000 [9]中国科学技术大学附属第一医院(安徽省立医院)妇产科,安徽合肥230001 [10]兰州大学第一医院妇产科,甘肃兰州730000 [11]郑州大学第二附属医院妇产科,河南郑州450014 [12]广州医科大学公共卫生学院,广东广州511436 [13]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6期669-672,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);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：目的从肿瘤学结局角度探讨FIGO 2018子宫颈癌分期Ⅲ期各亚期设置的合理性。方法在中国子宫颈癌临床诊疗项目大数据库中筛选FIGO 2018新分期Ⅲ期子宫颈癌患者,比较FIGO 2018ⅢA、ⅢB、ⅢCr和ⅢCp期患者之间的5年总体生存率(OS)和无瘤生存率(DFS)。结果(1)纳入符合入组条件的FIGO 2018分期子宫颈癌患者7045例(ⅢA期245例、ⅢB期1786例、ⅢCr期1879例、ⅢCp期3135例),中位随访时间45个月(ⅢA期36个月,ⅢB期37个月,ⅢCr期54个月,ⅢCp期53个月)。(2)Kaplan-Meier分析显示Ⅲ期子宫颈癌患者5年OS(ⅢA期vs.ⅢB期vs.ⅢCr期vs.ⅢCp期,73.4%vs.68.7%vs.68.8%vs.76.9%,P<0.001)和5年DFS(ⅢA期vs.ⅢB期vs.ⅢCr期vs.ⅢCp期,64.2%vs.60.4%vs.65.4%vs.65.9%,P<0.001)差异具有统计学意义。(3)Cox多因素分析显示,与ⅢCp期相比,ⅢA期不是患者死亡及复发/死亡的独立危险因素(OS:HR=1.163,95%CI 0.858~1.576,P=0.330;DFS:HR=1.097,95%CI 0.853~1.412,P=0.469)。ⅢB期、ⅢCr期发生死亡和复发/死亡的风险均高于ⅢCp期;ⅢB期发生死亡的风险是ⅢCp期的1.456倍(HR=1.456,95%CI 1.273~1.664,P<0.001),发生复发/死亡的风险是ⅢCp期的1.353倍(HR=1.353,95%CI 1.212~1.511,P<0.001);ⅢCr期发生死亡的风险是ⅢCp期的1.378倍(HR=1.378,95%CI 1.200~1.582,P<0.001),发生复发/死亡的风险是ⅢCp期的1.158倍(HR=1.158,95%CI 1.031~1.300,P=0.013)。结论从肿瘤学结局角度分析,FIGO 2018ⅢA期与ⅢCp期的肿瘤学结局相当,但ⅢCp期肿瘤学结局优于ⅢB、ⅢCr期。FIGO 2018子宫颈癌分期Ⅲ期各亚期设置欠合理。Objective To explore the rationality of the stageⅢsubstaging in FIGO 2018 new staging from the perspective of oncology outcome.Methods Patients with cervical cancer in the new stageⅢof FIGO 2018 were selected from Four C Database.The 5-year OS and DFS of patients with stageⅢA,ⅢB,ⅢCr andⅢCp of FIGO 2018 were compared.Results(1)Totally 7045 patients with cervical cancer were enrolled in FIGO 2018 stageⅢ(stageⅢA 245,stageⅢB 1786,stageⅢCr1879,stageⅢCp 3135).The median follow-up period was 45 months(stageⅢA vs.stageⅢB vs.stageⅢCr vs.stageⅢCp:36 months vs.37 months vs.54 months vs.53 months).(2)Kaplan-Meier analysis showed that there was statistical difference in 5-year OS and 5-year DFS of patients with stageⅢcervical cancer(5-year OS:stageⅢA vs.ⅢB vs.ⅢCr vs.ⅢCp,73.4%vs.68.7%vs.68.8%vs.76.9%,P<0.001;5-year DFS:stageⅢA vs.ⅢB vs.ⅢCr vs.ⅢCp,64.2%vs.60.4%vs.65.4%vs.65.9%,P<0.001).(3)Multivariate analysis showed that compared with stageⅢCp,stageⅢA was not an independent risk factor for death and recurrence/death(OS:HR=1.163,95%CI 0.858~1.576,P=0.330;DFS:HR=1.097,95%CI 0.853~1.412,P=0.469).The risk of death and recurrence/death in stageⅢB and stageⅢCr was higher than that in stageⅢCp.The risk of death in stageⅢB was 1.456 times higher than that in stageⅢCp(HR=1.456,95%CI 1.273~1.664,P<0.001),and the risk of recurrence/death was 1.353 times higher than that in stageⅢCp(HR=1.664,95%CI 1.212~1.511,P<0.001).The risk of death in stageⅢCr was 1.378 times higher than that in stageⅢCp(HR=1.378,95%CI1.200~1.582,P<0.001),and the risk of recurrence/death was 1.158 times higher than that in stageⅢCp(HR=1.158,95%CI 1.031~1.300,P=0.013).Conclusion From the perspective of oncology outcome,the oncology outcome of FIGO 2018 stageⅢA is similar to that of stageⅢCp,but the oncology outcome of stageⅢCp is better than that of stageⅢB andⅢCr.The stageⅢsubstaging of FIGO 2018 new staging of cervical cancer is unreasonable.

关 键 词：子宫颈肿瘤 国际妇产科联盟 Ⅲ期 肿瘤学结局 

分 类 号：R737.3[医药卫生—肿瘤]