熊樱, 梁立治, 刘继红, 彭小萍, 魏梅, 沈扬, 李孟达. 宫颈鳞癌预后因素的层别化及其临床意义[J]. 中国肿瘤临床, 2007, 34(18): 1048-1052.
引用本文: 熊樱, 梁立治, 刘继红, 彭小萍, 魏梅, 沈扬, 李孟达. 宫颈鳞癌预后因素的层别化及其临床意义[J]. 中国肿瘤临床, 2007, 34(18): 1048-1052.
Xiong Ying, Liang Lizhi, Liu Jihong, Peng Xiaoping, Wei Mei, Shen Yang, Li Mengda. Stratification of Prognostic Factors for Squamous Cell Carcinoma of the Cervix and Its Clinical Significance[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2007, 34(18): 1048-1052.
Citation: Xiong Ying, Liang Lizhi, Liu Jihong, Peng Xiaoping, Wei Mei, Shen Yang, Li Mengda. Stratification of Prognostic Factors for Squamous Cell Carcinoma of the Cervix and Its Clinical Significance[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2007, 34(18): 1048-1052.

宫颈鳞癌预后因素的层别化及其临床意义

Stratification of Prognostic Factors for Squamous Cell Carcinoma of the Cervix and Its Clinical Significance

  • 摘要: 目的 :探讨影响宫颈鳞癌预后的因素,将其按预后风险水平层别化,并建立预后预测系统以指导个体化治疗方案。 方法 :对287例FIGOⅠb1~Ⅱb期宫颈鳞癌的临床病理资料和随访结果进行分析,通过单因素和多因素分析筛选并层别化预后影响因素。 结果 :287例患者5年无瘤生存率为81.3%。多重COX回归分析显示,影响预后的独立因素为盆腔淋巴结转移(P<0.001)和宫旁切缘阳性(P=0.013)(A级因素)、宫颈深肌层浸润(P=0.035)(B级因素)。具有A级因素者局部复发率、局部伴远处转移率和远处转移率分别为27.4%、4.1%和13.7%;具有B级因素者局部复发率为20.0%,局部伴远处转移率为1.1%,远处转移率为1.1%;无A级或B级因素者局部复发率为9.2%,局部伴远处转移率为1.7%,远处转移率为0.8%。根据A级和B级因素建立预后预测系统,高危组患者具有A级因素,5年无瘤生存率为25.0%~61.3%;中危组患者无A级因素但具有B级因素,5年无瘤生存率为83.7%;低危组患者无A级或B级因素,5年无瘤生存率为93.9%。 结论 :盆腔淋巴结转移、宫旁切缘阳性、宫颈深肌层浸润为影响宫颈鳞癌预后的因素。具有上述不同因素的患者预后风险及复发模式有所不同,有必要采取个体化的治疗来提高远期疗效。

     

    Abstract: Objective :To investigate and stratify the prognostic factors of cervical squamous cellcarcinoma according to the corresponding prognostic risks and to establish a prognosis-predictive sys-tem. Methods :The clinicopathological data and follow-up results of 287 cases of cervical squamouscell carcinoma were analyzed. The prognostic factors were identified and stratified by univariate andmultivariate analysis. Results :The 5-year disease-free survival (DFS) rate was 81.3% for the 287cases. Multiple Cox regression analysis identified pelvic node metastasis (P<0.001), positive parametrialsurgical margin (P=0.013) (class A factors) and deep stromal invasion (P=0.035) (class B factor) as prog-nostic factors. Local recurrence, local recurrence plus distant metastasis and distant metastasis wereseen in 27.4%, 4.1% and 13.7% of patients with class A factor(s), 20.0%, 1.1% and 1.1% of those withclass B factors, and 9.2%, 1.7% and 0.8% of the patients with neither class A nor class B factors, re-spectively. A prognosis-predictive system based on class A and class B factors was established. Patientswith class A factor(s) were divided into the high risk group with 5-year DFS rate ranging from 25.0% to61.3%, patients with class B factors were in the intermediate risk group with a DFS rate of 83.7%,while patients with neither A nor B factors were in the low risk group with a DFS rate of 93.9%. Con-Clusion :Pelvic node metastasis, positive parametrial surgical margin, and deep stromal invasion are fac-tors that influence the prognosis of squamous cell carcinoma of the cervix. Patients with the above fac-tors have various levels of prognostic risk and different patterns of recurrence, therefore individualizedtreatment should be considered.

     

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