基于监测、流行病学和最终结果数据库的子宫颈透明细胞腺癌预后因素分析  

Analysis of prognostic factors for clear cell adenocarcinoma of the uterine cervix based on the Surveillance,Epidemiology and End Results database

作　　者：刘志艳 薛瑞峰[2] 王洋[1] 耿建昊 杜荣旭 李永恒[1] 王维虎 Liu Zhiyan;Xue Ruifeng;Wang Yang;Geng Jianhao;Du Rongxu;Li Yongheng;Wang Weihu(Department of Radiation Oncology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China;Department of Bone and Soft Tissue Tumor,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所放疗科、恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所骨与软组织肿瘤科、恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《肿瘤研究与临床》2024年第3期161-166,共6页Cancer Research and Clinic

摘　　要：目的基于监测、流行病学和最终结果(SEER)数据库探讨子宫颈透明细胞腺癌(CCAC)的预后相关因素。方法收集1976年至2017年SEER数据库中431例确诊CCAC患者临床资料。采用Kaplan-Meier法进行生存分析,亚组比较采用log-rank检验。采用Cox比例风险模型分析总生存(OS)的影响因素。结果431例患者中位年龄[M(Q1,Q3)]54岁(40岁,71岁),白种人333例(77.3%)。431例患者中位OS时间93个月(95%CI:47~148个月),1、2、5年OS率分别为80.1%、65.8%、54.2%。美国癌症联合委员会(AJCC)分期Ⅰ期患者中位OS时间未达到,Ⅱ期为83个月(95%CI:21~144个月),Ⅲ期为32个月(95%CI:16~47个月),Ⅳ期为9个月(95%CI:5~13个月),4个分期间OS差异有统计学意义(P<0.001)。SEER分期局部病变期患者中位OS时间未达到,区域病变期为46个月(95%CI:8~83个月),远处转移期为9个月(95%CI:5~12个月),3个分期间OS差异有统计学意义(P<0.001)。有明确和部分未明确AJCC分期的患者中,118例接受单纯手术治疗,119例接受术后放疗,两组中位OS时间分别为443个月(95%CI:162~723个月)、102个月(95%CI:75~129个月),两组OS差异有统计学意义(P<0.001)。AJCC分期Ⅰ期中单纯手术组与术后放疗组5年OS率分别为82.5%和78.5%,Ⅱ期分别为80.0%和52.3%,Ⅲ期分别为27.8%和63.3%;各期中两组OS差异均无统计学意义(均P>0.05)。SEER分期局部病变期中单纯手术组和术后放疗组5年OS率分别为88.9%和73.1%,差异有统计学意义(P=0.012);区域病变期分别为45.5%和60.0%,差异无统计学意义(P=0.568)。多因素Cox回归分析结果显示,AJCC分期(Ⅰ期比Ⅳ期,HR=0.281,95%CI:0.178~0.543,P<0.001;Ⅱ期比Ⅳ期,HR=0.347,95%CI:0.113~0.439,P<0.001;Ⅲ期比Ⅳ期,HR=0.399,95%CI:0.030~0.145,P<0.001)、SEER分期(局部病变期比远处转移期,HR=0.104,95%CI:0.059~0.182,P<0.001;区域病变期比远处转移期,HR=0.301,95%CI:0.195~0.463,P<0.001)、是否手术(是比否,HR=0.359,95%CI:0.241~0.535,P<0.001)是CCAC患者OS的独立Objective To explore the prognostic factors associated with clear cell adenocarcinoma(CCAC)of the uterine cervix based on data in the Surveillance,Epidemiology and End Results(SEER)database.Methods Clinical data were collected from 431 patients with confirmed CCAC in the SEER database from 1976 to 2017.Survival analysis was performed using the Kaplan-Meier method with log-rank test for comparison between subgroups.Cox proportional hazards model was used to analyze the influencing factors of overall survival(OS).Results The median age[M(Q1,Q3)]of 431 patients was 54 years old(40 years old,71 years old);there were 333 cases(77.3%)of whit.The median OS time of 431 patients was 93 months(95%CI:47-148 months),and the 1-,2-,and 5-year OS rates were 80.1%,65.8%and 54.2%,respectively.The median OS time was not reached in patients with American Joint Committee on Cancer(AJCC)stageⅠ,83 months(95%CI:21-144 months)for stageⅡ,32 months(95%CI:16-47 months)for stageⅢ,and 9 months(95%CI:5-13 months)for stageⅣ(P<0.001).Median OS time was not reached in patients with SEER stage of localized lesions,46 months(95%CI:8-83 months)for regional lesions stage,and 9 months(95%CI:5-12 months)for distant metastases stage(P<0.001).Of the patients with clear AJCC staging and some with unspecified AJCC staging,118 received surgical treatment alone and 119 received postoperative radiotherapy,the median OS time of the two groups was 443 months(95%CI:162-723 months)and 102 months(95%CI:75-129 months),and the difference in OS between the two groups was statistically significant(P<0.001).Among the patients with AJCC stageⅠ,the 5-year OS rates in surgery-only group and postoperative radiotherapy group were 82.5%and 78.5%,the stageⅡwere 80.0%and 52.3%,and the stageⅢwere 27.8%and 63.3%,respectively;the differences in OS between different stages were not statistically significant(all P>0.05).Among the patients with SEER localized lesions stage,the 5-year OS rates in surgery-only group and postoperative radiotherapy group were 88.9%and 73.

关 键 词：宫颈肿瘤 腺癌 透明细胞 放射疗法 预后 

分 类 号：R737.33[医药卫生—肿瘤]