宫颈癌淋巴结阴性患者的预后及其危险因素  

The prognosis of patients with stage Ⅰb-Ⅱb node-negative cervical carcinoma

作　　者：程玺[1] 蔡树模[1] 李子庭[1] 王香娥[1] 丁亚琴[1] 薛木泉[1] 

机构地区：[1]复旦大学附属肿瘤医院妇瘤科,上海200032

出　　处：《中国癌症杂志》2003年第6期534-536,551,共4页China Oncology

摘　　要：目的 :探讨Ⅰb～Ⅱb期宫颈癌盆腔淋巴结阴性患者的预后以及影响预后的危险因素。方法 :回顾性分析了 1993年 11月～ 1997年 12月 2 36例Ⅰb～Ⅱb期 (FIGO分期 )宫颈癌根治术后证实盆腔淋巴结阴性患者的预后。生存曲线用Kaplan Meier方法。生存率比较采用Logrank检验。Cox比例风险模型分析预后因素。 结果 :本组盆腔淋巴结阴性患者的五年总体生存率为 82 0 % ,中位生存时间 10 0 0月。本组患者的复发和 (或 )转移率为19 5 % ,五年生存率为 16 9% ,中位生存时间为 15 0月。单因素分析结果显示临床分期Ⅱb ,宫颈肿瘤巨大 ,非鳞癌组织类型 ,低分化 ,深肌层浸润 ,宫旁浸润 ,阴道残端有癌残留 ,脉管有癌栓的患者预后不良 (P <0 0 5 )。Cox比例风险模型对可能影响预后的 12个临床因素进行了多因素分析 ,结果显示 :年龄 ,宫颈肿瘤大小 ,组织学类型 ,分化程度 ,宫旁浸润和阴道残端癌残留是影响无淋巴结转移患者预后最重要的危险因素 (P <0 0 5 )。结论 :Ⅰb～Ⅱb期宫颈癌盆腔淋巴结阴性患者的预后较好 ,但宫颈肿瘤巨大 ,非鳞癌类型 ,低分化 ,宫旁浸润及阴道切缘阳性的患者预后不良 ,也应给予必要的治疗 ,以减少盆腔复发和远处转移。Purpose:To investigate the survival and prognostic factors in patients with stage Ib～IIb node-negative cervical carcinoma.Methods:From Nov.1993 to Dec. 1997,236 patients who had radical hysterectomy and pelvic lymphadenectomy and pelvic lymph node found negative were reviewed retrospectively. Survival rates were calculated by Kaplan-Meier method with differences in survival estimated by Log-rank test. Independent prognostic factors were identified by the Cox's proportional-hazards regression model. Results:The overall 5-year survival of the patients was 82.0% and the median survival time was 100.0 months. The recurrence and/or metastatic rate was 19.5%. Of these patients the 5-year survival rate was 16.9% and median survival time was 15.0 months. Among the variables,clinical stage(Ⅱb),tumor size(≥4 cm),histological type (non-squamous carcinoma),poor differentiation,deep stromal invasion,parametrial extension,vaginal margin involved,and lymphvascular permeation were the poor prognostic factors in univariate survival analysis ( P <0.05).Cox proportional hazard model analysis showed age,size of the tumor,histopathological type,cellular differentiation,parametrial extension and vaginal margin involvement were independent prognostic factors ( P <0.05).Conclusions:The survival of the patients with negative pelvic lymph node was relatively good. However,the patients with barrel-shape cervical carcinoma, non-squamous type,poor differentiation,parametrial extension and vaginal margin involved had poorer survival. Adequate treatment should be given in order to decrease the pelvic recurrence and distant metastases.

关 键 词：宫颈癌 盆腔淋巴结阴性 预后 生存率 

分 类 号：R737.33[医药卫生—肿瘤]