宫颈癌合并生殖道感染患者临床特征及放化疗预后影响因素分析  

Analysis of characteristics and prognostic factors of radiotherapy and chemotherapy in patients with cervical cancer complicated with reproductive tract infection

作　　者：谢星韵 陈文娟[1] 曹桂华 Xie Xingyun;Chen Wenjuan;Cao Guihua(Department of Gynecological Oncology Radiotherapy,Fujian Cancer Hospital,Fuzhou 350104,China;Department of Pharmacy,Fujian Cancer Hospital,Fujian Medical University,Fuzhou 350104,China)

机构地区：[1]福建省肿瘤医院妇科肿瘤放疗科,福州350104 [2]福建医科大学肿瘤临床医学院、福建省肿瘤医院药剂科,福州350104

出　　处：《实用医技杂志》2024年第10期690-695,共6页Journal of Practical Medical Techniques

基　　金：福建省科技创新联合资金项目(攀登项目)(2023Y9446)。

摘　　要：目的总结宫颈癌合并生殖道感染患者的临床特征,并分析放化疗预后及其影响因素。方法本研究为单中心回顾性队列研究,收集2018年1月至2020年8月福建省肿瘤医院行放化疗的宫颈癌合并生殖道感染的患者,归纳总结患者的临床特征,采用Kaplan-Meier法计算并比较2组患者的无进展生存(PFS)时间、总生存(OS)时间,对预后的相关因素进行单因素及多因素logistic回归分析。结果共80例患者纳入本研究,患者的中位诊断年龄为55.5岁,最常见的症状为阴道不规则出血。病理类型最常见的是鳞状细胞癌(74/80,92.5%)。96.3%(77/80)来自农村。13例(16.3%)有糖尿病。依据国际妇产科联盟(FIGO)2018分期对所有患者进行重新分期,其中Ⅱa期1例(1.3%),Ⅱb期26例(32.5%),Ⅲb期12例(15.0%),Ⅲc期32例(40%),Ⅳa期5例(6.2%),Ⅳb期4例(5.0%)。39例(48.7%)患者无淋巴结转移,41例(51.3%)盆腔淋巴结转移,8例(10.0%)腹膜后淋巴结转移,2例(2.5%)腹股沟、左锁骨上淋巴结转移。肿瘤形态呈结节型50例(62.5%),菜花型28例(35.0%),空洞型2例(2.5%)。肿瘤最大径≤4 cm的患者13例(16.3%),>4 cm 67例(83.7%)。有52例(65.0%)行宫颈或阴道分泌物病原检查,病原学检测阴性18例(34.6%),阳性34例(65.4%)。病原学排名前3位的常见细菌为大肠埃希菌18例(53.0%)、粪肠球菌11例(32.4%)、肺炎克雷伯6例(17.7%)。病原学阳性的患者中单纯感染占61.8%(2/34),混合感染占38.2%(13/34)。35例患者有C反应蛋白(CRP)、降钙素原(PCT)实验室检查结果,CRP中位数30(3.7~174.0)mg/ml,PCT中位数0.05(0.02,0.66)ng/ml。80例患者的3年生存率为75.0%,5年生存率43.8%。3年无进展生存率68.8%,5年无进展生存率为42.5%。在单因素COX回归模型中,分期、贫血情况、肿瘤形态、淋巴结转移情况、治疗前鳞状细胞癌抗原(SCC)和肿瘤最大径均为患者生存情况的显著影响因素。将单因素模型中显著的变量纳入多因素Cox回归模型中,�Objective To summarize the clinical characteristics of patients with cervical cancer complicated with reproductive tract infection and analyze the prognosis and influencing factors of radiotherapy and chemotherapy.Methods This study was a single-center retrospective cohort study.Patients with cervical cancer complicated with reproductive tract infection who underwent radiotherapy and chemotherapy in Fujian Cancer Hospital from January 2018 to August 2020 were collected.The clinical characteristics of the patients were summarized.The Kaplan-Meier method was used to calculate and compare the progression-free survival(PFS)time and overall survival(OS)time of the two groups of patients.Univariate and multivariate logistic regression analyses were performed on the related factors of prognosis.Results A total of 80 patients were included in this study.The median diagnostic age of the patients was 55.5 years old.The most common symptom was irregular vaginal bleeding.The most common pathological type was squamous cell carcinoma(92.5%,74/80).96.3%(77/80)were from rural areas.13 cases had diabetes(16.3%).All patients were restaged according to the 2018 FIGO staging.Among them,1 case was in stageⅡa(1.3%),26 cases were in stageⅡb(32.5%),12 cases were in stageⅢb(15.0%),32 cases were in stageⅢc(40%),5 cases were in stageⅣa(6.2%),and 4 cases were in stageⅣb(5.0%).Thirty-nine cases(48.7%)had no lymph node metastasis,41 cases(51.3%)had pelvic lymph node metastasis,8 cases(10.0%)had retroperitoneal lymph node metastasis,and 2 cases(2.5%)had inguinal and left supraclavicular lymph node metastasis.There were 50 cases(62.5%)with nodular tumor morphology,28 cases(35.0%)with cauliflower-like tumor morphology,and 2 cases(2.5%)with cavitary tumor morphology.There were 13 cases(16.3%)of patients with a maximum tumor diameter of≤4 cm,and 67 cases(83.7%)with a maximum tumor diameter greater than 4 cm.Fifty-two cases(65.0%)underwent pathogen examination of cervical or vaginal secretions.There were 18 cases(34.6%)with negative p

关 键 词：宫颈肿瘤 生殖道感染 生存分析 

分 类 号：R737.33[医药卫生—肿瘤] R711.3[医药卫生—临床医学]