宮頸癌156例術(shù)后復(fù)發(fā)及預(yù)后相關(guān)因素分析
發(fā)布時間：2018-07-22 10:30
【摘要】：目的：探討我院宮頸癌手術(shù)治療后復(fù)發(fā)及預(yù)后的臨床病理相關(guān)因素、臨床特點、治療方式，為減少我院宮頸癌術(shù)后復(fù)發(fā)，提高宮頸癌患者手術(shù)后生存率及改善預(yù)后提供依據(jù)。 方法：選擇2007年1月1日至2008年12月31日期間河北醫(yī)科大學第四醫(yī)院婦科收治的，經(jīng)手術(shù)治療、有病理診斷、病歷資料及隨訪資料完整的156例（依據(jù)國際婦產(chǎn)科聯(lián)盟2009年分期）宮頸癌患者，共有22例患者復(fù)發(fā)，采用回顧性分析，統(tǒng)計臨床病歷資料、病理資料及隨訪資料。156例患者均符合以下的納入標準：①所有患者均行宮頸癌根治術(shù)（廣泛子宮切除術(shù)+盆腔淋巴結(jié)清掃術(shù)），并且經(jīng)術(shù)后病理證實為宮頸癌；②復(fù)發(fā)的診斷:主要通過病理診斷，腫瘤再次出現(xiàn)部位的活檢及穿刺病理證實；其次為臨床診斷發(fā)生遠處肺、骨轉(zhuǎn)移無法獲得病理診斷，可依靠癥狀、體征及輔助檢查進行診斷[2]；③臨床病歷資料、病理資料完整，有比較規(guī)范、系統(tǒng)的隨訪資料。所有病例都采用電話隨訪方式。隨訪開始于所有治療完成后，隨訪時間截止到2013年12月，末次隨訪覆蓋全部入組的研究對象。患者生存時間是指從患者接受手術(shù)當日到末次隨訪時間或該研究對象死亡的這段時間。患者復(fù)發(fā)時間是指從患者接受手術(shù)當日到該研究對象復(fù)發(fā)的這段時間。對研究對象的年齡、臨床分期、原發(fā)腫瘤大小、病理類型、腫瘤的組織分化程度、肌層浸潤深度、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移、不同治療方式等可能的復(fù)發(fā)及預(yù)后影響因素進行單因素和（或）多因素分析。本研究采用SPSS13.0軟件包進行統(tǒng)計學分析，采用Kaplan-Meier法統(tǒng)計生存率，并繪制相應(yīng)生存曲線，生存率及復(fù)發(fā)相關(guān)因素對比使用log-rank test，使用COX比例風險回歸模型對單因素檢驗中有統(tǒng)計學意義（P0.05）的各影響因素進行復(fù)發(fā)及預(yù)后的多因素分析。統(tǒng)計分析結(jié)果均以P0.05代表有統(tǒng)計學意義。對于隨訪期間腫瘤以外因素死亡的患者及末次隨訪時仍然存活、未復(fù)發(fā)的患者，統(tǒng)計分析時均當作截尾數(shù)據(jù)處理。 結(jié)果： 1156例宮頸癌患者中有22例復(fù)發(fā)，，全組的復(fù)發(fā)率為14.10%。單因素分析顯示臨床分期較早組（≤Ⅰb2期）宮頸癌患者的復(fù)發(fā)率(9.30%)明顯低于臨床分期較晚組（＞Ⅰb2期）患者的復(fù)發(fā)率(20.00%)，差異有統(tǒng)計學意義（χ2=4.395，P=0.036）；鱗癌組患者的復(fù)發(fā)率(12.23%)明顯低于腺癌及其他病理類型組患者的復(fù)發(fā)率（29.41%），差異有統(tǒng)計學意義（χ2=5.409，P=0.020）；無脈管瘤栓組患者的復(fù)發(fā)率（10.61%）明顯低于有脈管瘤栓組患者的復(fù)發(fā)率（33.33%），差異有統(tǒng)計學意義（χ2=13.824，P=0.000）；無盆腔淋巴結(jié)轉(zhuǎn)移組患者的復(fù)發(fā)率（11.02%）明顯低于有盆腔淋巴結(jié)轉(zhuǎn)移組患者的復(fù)發(fā)率（27.59%），差異有統(tǒng)計學意義（χ2=22.455，P=0.000）；即臨床分期、病理類型、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移對宮頸癌患者復(fù)發(fā)的影響有統(tǒng)計學意義。而年齡、原發(fā)腫瘤大小、腫瘤的組織分化程度、肌層浸潤深度、不同治療方式對宮頸癌患者復(fù)發(fā)的影響無統(tǒng)計學意義（P＞0.05)。多因素分析顯示有無脈管瘤栓是決定宮頸癌術(shù)后復(fù)發(fā)的獨立因素，P值為0.004。 2156例宮頸癌患者中有31例死亡，全組的5年生存率為80.13%，單因素分析顯示臨床分期較早組（≤Ⅰb2期）宮頸癌患者的5年生存率(88.37%)明顯高于臨床分期較晚組（＞Ⅰb2期）患者的5年生存率（70.00%），差異有統(tǒng)計學意義（χ2=8.767，P=0.003）；鱗癌組患者的5年生存率（83.21%）明顯高于腺癌及其他病理類型組患者的5年生存率（57.89%），差異有統(tǒng)計學意義（χ2=12.078，P=0.001），淺肌層浸潤組患者的5年生存率（87.14%）明顯高于深肌層浸潤組患者的5年生存率（74.42%），差異有統(tǒng)計學意義（χ2=4.172，P=0.041）；無脈管瘤栓組患者的5年生存率（84.85%）明顯高于有脈管瘤栓組患者的5年生存率（54.17%），差異有統(tǒng)計學意義（χ2=13.824，P=0.000）；無盆腔淋巴結(jié)轉(zhuǎn)移組患者的5年生存率（86.61%）明顯高于有盆腔淋巴結(jié)轉(zhuǎn)移組患者的5年生存率（51.72%），差異有統(tǒng)計學意義（χ2=8.487，P=0.004），而年齡、原發(fā)腫瘤大小、腫瘤的組織分化程度、不同治療方式對宮頸癌術(shù)后5年生存率的影響無統(tǒng)計學意義，多因素分析顯示臨床分期、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移是影響宮頸癌術(shù)后5年生存率的獨立因素，P值分別為0.016、0.043和0.002。 結(jié)論： 1臨床分期、病理類型、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移是影響宮癌術(shù)后復(fù)發(fā)的臨床病理因素。其中有無脈管瘤栓是決定宮頸癌術(shù)后復(fù)發(fā)的獨立因素。 2臨床分期、病理類型、肌層浸潤深度、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移是影響宮頸癌術(shù)后5年生存率的臨床病理因素，其中臨床分期、有無脈管瘤栓、有無盆腔淋巴結(jié)轉(zhuǎn)移是影響宮頸癌術(shù)后5年生存率的獨立因素。
[Abstract]:Objective: To explore the clinicopathological factors, clinical features and treatment methods of the recurrence and prognosis of cervical cancer after surgical treatment in our hospital, in order to reduce the recurrence of cervical cancer in our hospital, improve the survival rate and improve the prognosis of cervical cancer patients.
Methods: from January 1, 2007 to December 31, 2008, the gynecologic department of Fourth Hospital of Hebei Medical University was treated with surgical treatment. There were 156 cases of cervical cancer with pathological diagnosis, medical records and follow-up data (according to the 2009 staging of the International Union of Obstetrics and Gynecology). There were 22 cases of recurrence. The retrospective analysis was used to analyze the clinical records. Data, pathological data and follow-up data were all in accordance with the following criteria: (1) all patients were treated with radical hysterectomy (extensive hysterectomy plus pelvic lymphadenectomy) and cervical cancer confirmed by postoperative pathology; and (2) the diagnosis of recurrence: the diagnosis of recurrence mainly through the diagnosis of the disease, the biopsy and puncture of the tumor in the reappearance site. It was confirmed that the next clinical diagnosis of distant lung, bone metastasis can not be pathological diagnosis, can rely on symptoms, signs and auxiliary examination of the diagnosis of [2]; 3. Clinical records, pathological data complete, a relatively standardized, systematic follow-up data. All cases are followed by electric telephone follow up. Follow up after all treatment, follow all treatment, follow. The duration of the patient's survival time refers to the period of time from the day of the operation to the last follow-up or the death of the subject. The time of the patient's recurrence refers to the time from the day of the operation to the relapse of the subject. Age, clinical staging, primary tumor size, pathological type, degree of tissue differentiation, depth of myometrium infiltration, or without vascular tumor thrombus, pelvic lymph node metastasis, possible recurrence and prognostic factors such as different treatments were analyzed by single factor and (or) multivariate analysis. The SPSS13.0 software package was used for statistical analysis. The Kaplan-Meier method was used to calculate the survival rate, and to draw the corresponding survival curve, the survival rate and the recurrence related factors were compared with log-rank test, and the COX proportional risk regression model was used to analyze the factors of statistical significance (P0.05) in the single factor test for the recurrence and prognosis of the multifactorin analysis. The statistical analysis results were all P0.05 representative statistics. For patients who died of tumor factors during follow-up and at the last follow-up, they were still alive, and those who did not relapse were treated as truncated data.
Result:
22 of the 1156 patients with cervical cancer relapsed, and the recurrence rate of the whole group was 14.10%. single factor analysis. The recurrence rate of the early clinical stage group (9.30%) was significantly lower than that of the late clinical stage group (> I B2 stage). The recurrence rate was 20% (20%), and the difference was statistically significant (x 2=4.395, P=0.036), and the patients in the squamous cell carcinoma group had a relapse. The recurrence rate (12.23%) was significantly lower than that of the adenocarcinoma and other pathological types (29.41%), and the difference was statistically significant (x 2=5.409, P=0.020); the recurrence rate (10.61%) in the non vascular tumor thrombus group (10.61%) was significantly lower than that of the patients with vascular tumor thrombus group (33.33%), and the difference was statistically significant (x 2=13.824, P=0.000); no pelvic lymph node transfer was found. The recurrence rate of the group (11.02%) was significantly lower than that of the pelvic lymph node metastasis group (27.59%), and the difference was statistically significant (x 2=22.455, P=0.000), that is, the clinical stage, the pathological type, the vascular tumor suppository, or not the pelvic lymph node metastasis has a statistically significant effect on the recurrence of the cervical cancer. The effect of different treatments on the recurrence of cervical cancer was not statistically significant (P > 0.05). The multiple factor analysis showed that there was an independent factor in the recurrence of cervical cancer after operation, and the value of P was 0.004..
31 of the 2156 cases of cervical cancer died and the 5 year survival rate of the group was 80.13%. The single factor analysis showed that the 5 year survival rate (88.37%) of the early clinical stage group (< < I B2 stage) was significantly higher than the 5 year survival rate (70%) in the late stage group (> I B2). The difference was statistically significant (x 2=8.767, P=0.003), and the squamous cell carcinoma group was statistically significant. The 5 year survival rate (83.21%) was significantly higher than that of the adenocarcinoma and other pathological types (57.89%). The difference was statistically significant (x 2=12.078, P=0.001). The 5 year survival rate (87.14%) of the patients with superficial myometrium infiltration (87.14%) was significantly higher than that of the deep myometrium infiltration group (74.42%), the difference was statistically significant (x 2=4.172, P=0.041) The 5 year survival rate (84.85%) in the non vascular tumor thrombus group (84.85%) was significantly higher than the 5 year survival rate (54.17%) in the patients with vascular tumor thrombus group (54.17%), and the difference was statistically significant (x 2=13.824, P=0.000), and the 5 year survival rate (86.61%) in the patients without pelvic lymph node metastasis was significantly higher than that of the pelvic lymph node metastasis group (51.72%), and the difference was unified. The study significance (x 2=8.487, P=0.004), the age, the size of the primary tumor, the degree of tissue differentiation, and the effect of different treatments on the 5 year survival rate after cervical cancer were not statistically significant. The multivariate analysis showed that the clinical stage, the vascular tumor thrombus or the pelvic lymph node metastasis was an independent factor affecting the 5 year survival rate of cervical cancer. P values are 0.016,0.043 and 0.002., respectively.
Conclusion:
1 clinical staging, pathological type, or without vascular tumor thrombus, or without pelvic lymph node metastasis are the clinicopathological factors affecting the recurrence of uterine cancer after operation. There are no vascular tumor thrombus, which is an independent factor to determine the recurrence of cervical cancer after operation.
2 clinical staging, pathological type, depth of myometrium infiltration, vascular tumor suppository, or not pelvic lymph node metastasis are the clinicopathological factors that affect the 5 year survival rate of cervical cancer after operation. There are no vascular tumor thrombus or pelvic lymph node metastasis as an independent factor affecting the 5 year survival rate of cervical cancer after operation.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33
本文編號：2137137
[Abstract]:Objective: To explore the clinicopathological factors, clinical features and treatment methods of the recurrence and prognosis of cervical cancer after surgical treatment in our hospital, in order to reduce the recurrence of cervical cancer in our hospital, improve the survival rate and improve the prognosis of cervical cancer patients.
Methods: from January 1, 2007 to December 31, 2008, the gynecologic department of Fourth Hospital of Hebei Medical University was treated with surgical treatment. There were 156 cases of cervical cancer with pathological diagnosis, medical records and follow-up data (according to the 2009 staging of the International Union of Obstetrics and Gynecology). There were 22 cases of recurrence. The retrospective analysis was used to analyze the clinical records. Data, pathological data and follow-up data were all in accordance with the following criteria: (1) all patients were treated with radical hysterectomy (extensive hysterectomy plus pelvic lymphadenectomy) and cervical cancer confirmed by postoperative pathology; and (2) the diagnosis of recurrence: the diagnosis of recurrence mainly through the diagnosis of the disease, the biopsy and puncture of the tumor in the reappearance site. It was confirmed that the next clinical diagnosis of distant lung, bone metastasis can not be pathological diagnosis, can rely on symptoms, signs and auxiliary examination of the diagnosis of [2]; 3. Clinical records, pathological data complete, a relatively standardized, systematic follow-up data. All cases are followed by electric telephone follow up. Follow up after all treatment, follow all treatment, follow. The duration of the patient's survival time refers to the period of time from the day of the operation to the last follow-up or the death of the subject. The time of the patient's recurrence refers to the time from the day of the operation to the relapse of the subject. Age, clinical staging, primary tumor size, pathological type, degree of tissue differentiation, depth of myometrium infiltration, or without vascular tumor thrombus, pelvic lymph node metastasis, possible recurrence and prognostic factors such as different treatments were analyzed by single factor and (or) multivariate analysis. The SPSS13.0 software package was used for statistical analysis. The Kaplan-Meier method was used to calculate the survival rate, and to draw the corresponding survival curve, the survival rate and the recurrence related factors were compared with log-rank test, and the COX proportional risk regression model was used to analyze the factors of statistical significance (P0.05) in the single factor test for the recurrence and prognosis of the multifactorin analysis. The statistical analysis results were all P0.05 representative statistics. For patients who died of tumor factors during follow-up and at the last follow-up, they were still alive, and those who did not relapse were treated as truncated data.
Result:
22 of the 1156 patients with cervical cancer relapsed, and the recurrence rate of the whole group was 14.10%. single factor analysis. The recurrence rate of the early clinical stage group (9.30%) was significantly lower than that of the late clinical stage group (> I B2 stage). The recurrence rate was 20% (20%), and the difference was statistically significant (x 2=4.395, P=0.036), and the patients in the squamous cell carcinoma group had a relapse. The recurrence rate (12.23%) was significantly lower than that of the adenocarcinoma and other pathological types (29.41%), and the difference was statistically significant (x 2=5.409, P=0.020); the recurrence rate (10.61%) in the non vascular tumor thrombus group (10.61%) was significantly lower than that of the patients with vascular tumor thrombus group (33.33%), and the difference was statistically significant (x 2=13.824, P=0.000); no pelvic lymph node transfer was found. The recurrence rate of the group (11.02%) was significantly lower than that of the pelvic lymph node metastasis group (27.59%), and the difference was statistically significant (x 2=22.455, P=0.000), that is, the clinical stage, the pathological type, the vascular tumor suppository, or not the pelvic lymph node metastasis has a statistically significant effect on the recurrence of the cervical cancer. The effect of different treatments on the recurrence of cervical cancer was not statistically significant (P > 0.05). The multiple factor analysis showed that there was an independent factor in the recurrence of cervical cancer after operation, and the value of P was 0.004..
31 of the 2156 cases of cervical cancer died and the 5 year survival rate of the group was 80.13%. The single factor analysis showed that the 5 year survival rate (88.37%) of the early clinical stage group (< < I B2 stage) was significantly higher than the 5 year survival rate (70%) in the late stage group (> I B2). The difference was statistically significant (x 2=8.767, P=0.003), and the squamous cell carcinoma group was statistically significant. The 5 year survival rate (83.21%) was significantly higher than that of the adenocarcinoma and other pathological types (57.89%). The difference was statistically significant (x 2=12.078, P=0.001). The 5 year survival rate (87.14%) of the patients with superficial myometrium infiltration (87.14%) was significantly higher than that of the deep myometrium infiltration group (74.42%), the difference was statistically significant (x 2=4.172, P=0.041) The 5 year survival rate (84.85%) in the non vascular tumor thrombus group (84.85%) was significantly higher than the 5 year survival rate (54.17%) in the patients with vascular tumor thrombus group (54.17%), and the difference was statistically significant (x 2=13.824, P=0.000), and the 5 year survival rate (86.61%) in the patients without pelvic lymph node metastasis was significantly higher than that of the pelvic lymph node metastasis group (51.72%), and the difference was unified. The study significance (x 2=8.487, P=0.004), the age, the size of the primary tumor, the degree of tissue differentiation, and the effect of different treatments on the 5 year survival rate after cervical cancer were not statistically significant. The multivariate analysis showed that the clinical stage, the vascular tumor thrombus or the pelvic lymph node metastasis was an independent factor affecting the 5 year survival rate of cervical cancer. P values are 0.016,0.043 and 0.002., respectively.
Conclusion:
1 clinical staging, pathological type, or without vascular tumor thrombus, or without pelvic lymph node metastasis are the clinicopathological factors affecting the recurrence of uterine cancer after operation. There are no vascular tumor thrombus, which is an independent factor to determine the recurrence of cervical cancer after operation.
2 clinical staging, pathological type, depth of myometrium infiltration, vascular tumor suppository, or not pelvic lymph node metastasis are the clinicopathological factors that affect the 5 year survival rate of cervical cancer after operation. There are no vascular tumor thrombus or pelvic lymph node metastasis as an independent factor affecting the 5 year survival rate of cervical cancer after operation.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33
【引證文獻】
相關(guān)期刊論文 前2條
1 郭玉萍;那仁花;古麗娜·庫爾班;;淋巴結(jié)陽性率在ⅠB～ⅡA期宮頸癌患者中的臨床意義[J];現(xiàn)代婦產(chǎn)科進展;2016年09期
2 黃莉莎;;1例宮頸癌術(shù)后復(fù)發(fā)大出血合并凝血障礙及高血糖病人的急救與護理[J];全科護理;2016年05期
本文編號：2137137
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