宫颈鳞癌术后肺转移时间与预后影响因素分析  

Analysis of the influencing factors of lung metastasis time and prognosis after cervical squamous cell carcinoma surgery

作　　者：童方琴 关萌 邹怡华 刘淑君 赵悦 王侠 TONG Fang-qin;GUAN Meng;ZOU Yi-hua;LIU Shu-jun;ZHAO Yue;WANG Xia(Department of Radiation,Af filiated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院放疗科,江苏徐州221002

出　　处：《中华肿瘤防治杂志》2023年第1期30-35,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81972845)。

摘　　要：目的 探讨宫颈鳞状细胞癌(CSCC)治疗后发生肺转移的时间及预后危险因素。方法 回顾性分析徐州医科大学附属医院2013-01-01-2019-04-30 CSCC根治术后发生肺转移的72例患者临床资料。依据无肺转移生存期(LMFS)的中位数将病例分为A、B 2组,其中LMFS<12个月为A组(35例),LMFS≥12个月为B组(37例)。应用Kaplan-Meier法计算生存率并绘制生存曲线,通过Cox风险回归模型进行单因素、多因素回归分析,判断影响患者预后的临床因素。结果 72例CSCC患者中位总生存期为40.0个月(95%CI:26.8~53.2),1、2、3年生存率分别为88.8%、72.7%和56.5%;发生肺转移后的中位总生存期为23.0个月(95%CI:16.1~29.9),1、2、3年生存率分别为77.1%、45.7%和28.7%。单因素分析结果显示,LMFS<12个月、腹腔镜手术、肿瘤长径≥4 cm、组织学低分化、脉管癌栓阳性、盆腔淋巴结阳性、原发病灶术后单纯放疗是CSCC肺转移预后的危险因素。Cox多因素分析显示,LMFS<12个月(HR=3.54,95%CI:1.69~7.41,P=0.001)、肿瘤长径≥4 cm(HR=2.25,95%CI:1.09~4.65,P=0.029)是CSCC肺转移预后的独立危险因素。结论 CSCC患者LMFS与总生存有关联,而与转移后生存无关联,延长LMFS有助于提高CSCC肺转移患者的生存预后。Objective To investigate the time and prognostic risk factors of lung metastasis after treatment of cervical squamous cell carcinoma(CSCC).Methods The clinical data of 72 patients with lung metastasis after CSCC radical operation in the Affiliated Hospital of Xuzhou Medical University from January 1,2013 to April 30,2019 were analyzed retrospectively.The patients were divided into group A and group B according to the median lung metastasis free survival(LMFS).Among them, group A(35 patients) had LMFS<12 months, and group B(37 patients) had LMFS≥12 months.Kaplan Meier method was used to calculate the survival rate and draw the survival curve.Cox risk regression model was used for single factor and multiple factor regression analyses to determine the clinical factors affecting the prognosis of patients.Results The median total survival time of 72 patients with CSCC was 40.0 months(95%CI:26.8-53.2),and the 1-,2-,and 3-year survival rates were 88.8%,72.7% and 56.5%,respectively;the median overall survival after lung metastasis was 23.0 months(95%CI:16.1-29.9),and the 1-,2-,and 3-year survival rates were 77.1%,45.7% and 28.7%,respectively.The results of univariate analysis showed that LMFS<12 months, laparoscopic surgery, tumor diameter ≥4 cm, histologically poorly differentiated, vascular tumor thrombus positive, pelvic lymph node positive, and radiotherapy alone after primary lesion surgery were the risk factors for the prognosis of lung metastasis in CSCC;Cox multivariate analysis showed that LMFS<12 months(HR=3.54,95%CI:1.69-7.41,P=0.001) and maximum tumor diameter ≥4 cm(HR=2.25,95%CI:1.09-4.65,P=0.029) were independent risk factors for the prognosis of lung metastasis in CSCC.Conclusions The LMFS is related to the overall survival of CSCC patients, but not to the survival after metastasis.Prolonging LMFS is helpful to improve the survival prognosis of CSCC patients with lung metastasis.

关 键 词：宫颈鳞癌 肺转移时间 COX风险模型 预后 影响因素分析 

分 类 号：R737.33[医药卫生—肿瘤]