子宫颈腺癌预后列线图的建立及优选治疗方式的探讨基于SEER数据库及中国单中心数据的回顾性研究  

Establishment of a prognostic nomogram and discussion on optimal treatment for cervical adenocarcinoma:a retrospective study based on SEER database and Chinese single-center data

作　　者：李响[1] 高玉华 杨卓[1] 马悦[1] 刘畅[1] 刘光聪 王丹波 Li Xiang;Gao Yuhua;Yang Zhuo;Ma Yue;Liu Chang;Liu Guangcong;Wang Danbo(Department of Gynecology,Cancer Hospital of Dalian University of Technology,Liaoning Cancer Hospital and Institute,Shenyang 110801,China)

机构地区：[1]大连理工大学附属肿瘤医院,辽宁省肿瘤医院妇科,沈阳110801

出　　处：《中华妇产科杂志》2024年第4期307-319,共13页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的基于美国国立癌症研究所的监测、流行病学及最终结果(SEER)数据库及中国单中心数据建立并验证预测子宫颈腺癌患者预后的列线图,探讨子宫颈腺癌的优选治疗方式。方法本研究从SEER数据库筛选出2478例子宫颈腺癌患者作为训练队列,并选择辽宁省肿瘤医院收治的195例子宫颈腺癌患者作为外部验证队列,收集两个队列患者的临床病理资料及随访数据;放疗组为同步放化疗为主的综合治疗,手术组为根治性手术为主的综合治疗。采用log-rank检验和Cox回归方法分析影响子宫颈腺癌患者预后的相关因素,建立预测子宫颈腺癌患者3年、5年总生存率的列线图,并进行SEER数据库训练队列的内部验证及本院数据验证队列的外部验证。结果(1)SEER数据库训练队列中,放疗组385例(15.54%,385/2478),手术组2093例(84.46%,2093/2478);放疗组患者的总生存时间为(55.8±51.3)个月,手术组为(94.4±61.7)个月,两组比较,差异有统计学意义(χ^(2)=256.44,P<0.001)。log-rank检验显示,年龄、婚姻状态、肿瘤最大径、病理分级、国际妇产科联盟(FIGO)分期、治疗方式均为显著影响子宫颈腺癌患者总生存时间的因素(P均<0.001)。多因素Cox回归分析显示,高龄(>50岁)、单身状态、肿瘤最大径(>4 cm)、病理分级高(G2、G3)及FIGO分期晚(≥Ⅱa2期)均为影响子宫颈腺癌患者总生存时间的独立危险因素(P均<0.05);而与放疗比较,手术是子宫颈腺癌患者预后的保护因素(HR=0.619,95%CI为0.494~0.777;P<0.001)。对局部晚期、Ⅲc期患者的进一步分析显示,手术是肿瘤最大径>4~<6 cm的局部晚期(Ⅰb3、Ⅱa2期;HR=0.414,95%CI为0.182~0.942;P=0.036)、Ⅲc T1~T2期(HR=0.473,95%CI为0.307~0.728;P=0.001)子宫颈腺癌患者预后的保护因素。(2)本院数据的外部验证队列中,放疗组39例(20.00%,39/195),手术组156例(80.00%,156/195);放疗组患者的总生存时间为(51.7±34.3)个月,显著低于手术组的Objective To establish and validate a predicting nomogram for cervical adenocarcinoma based on surveillance,epidemiology and end results(SEER)database and Chinese single-center data,and to explore the optimal treatment for cervical adenocarcinoma.Methods This study selected 2478 cervical adenocarcinoma patients from the SEER database as the training cohort,and 195 cervical adenocarcinoma patients from Cancer Hospital of Dalian University of Technology,Liaouing Cancer Hospital and Institute as an external validation cohort.Clinicopathological information and follow-up data of the two cohorts were collected.The radiotherapy group was defined as receiving comprehensive treatment based on concurrent chemoradiotherapy after initial diagnosis,while the surgery group was defined as receiving comprehensive treatment based on radical surgery.Log-rank test and cox regression were used to evaluate factors affecting the prognosis of cervical adenocarcinoma patients.A nomogram was drawn to predict the 3-year and 5-year overall survival rates of cervical adenocarcinoma patients,and then internal validation of the training cohort from SEER database and external validation of the hospital cohort were conducted.Results(1)In the SEER database training cohort,there were 385 patients(15.54%,385/2478)in the radiotherapy group and 2093 patients(84.46%,2093/2478)in the surgery group.Overall survival time of the radiotherapy group was(55.8±51.3)months,while that of the surgery roup was(94.4±61.7)months,the difference between the two groups was statistically significant(χ^(2)=256.44,P<0.001).Log-rank test showed that age,marital status,maximum of tumor diameters,pathological grade,International Federation of Gynecology and Obstetrics(FIGO)stage,and treatments were all significant factors affecting the overall survival time of cervical adenocarcinoma patients(all P<0.001).Multivariate Cox regression analysis showed that elder(>50 years old),single status,huge tumors(>4 cm),high pathological grades(G2,G3),and advanced FIGO stages(≥Ⅱ

关 键 词：宫颈肿瘤 腺癌 子宫切除术 化放疗 列线图 预后 回顾性研究 

分 类 号：R737.33[医药卫生—肿瘤]