Grisaru Dan A, Covens Allan, Franssen Edmee, Chapman William, Shaw Patricia, Colgan Terence, Murphy Joan, DePetrillo Denny, Lickrish Gordon, Laframboise Stefane, Rosen Barry
Division of Gynecological Oncology, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2003 Apr 15;97(8):1904-8. doi: 10.1002/cncr.11269.
The authors evaluated clinical and pathologic factors that predicted for recurrence after patients underwent radical surgery for International Federation of Gynecology and Obstetrics (FIGO) Stage IA(2)-IB(1-2) cervical carcinoma and developed a simple method of scoring those predictive factors to quantify outcome.
An analysis was conducted of a prospective radical surgery cervical carcinoma data base. A Cox proportional hazards regression analysis was done for each of the individual factors to estimate individual risk ratios using all available data for each factor. Stepwise and best-model options were used to identify the best combinations as predictors and to calculate adjusted risk ratios. Based on the information obtained, each patient was assigned a categorical score to predict recurrence. The variables used for the score were dichotomized. The differences between the scores in time to recurrence were evaluated using the log-rank test to compare the time to recurrence curves that were generated with the Kaplan-Meier method.
Eight hundred seventy-one patients were included in the study, and 66 patients who developed recurrent disease after a median follow-up of 49 months. Tumor size, maximum depth of invasion, pelvic lymph node status, tumor grade, and capillary lymphatic space (CLS) were single predictors for recurrence, and the score, which was based on combinations of these factors, predicted the disease free survival. Maximum depth of invasion, pelvic lymph node status, and CLS were the best combined predictors for recurrence, and they were used to form a second, precise scoring system to predict disease free survival (P < 0.0001; log-rank test).
The scoring system based on maximal depth of invasion, CLS, and pelvic lymph node metastases identified four strata of patients with distinct recurrence free survival. The incremental presence of each factor decreased recurrence free survival after patients underwent radical surgery. Patients with the presence of all three factors had a 5-year recurrence free survival rate of 65%. These patients would be suitable for studies of postoperative adjuvant therapy to improve outcome.
作者评估了国际妇产科联盟（FIGO）IA（2）-IB（1-2）期宫颈癌患者接受根治性手术后预测复发的临床和病理因素，并开发了一种对这些预测因素进行评分的简单方法以量化预后。
对一个前瞻性根治性手术宫颈癌数据库进行分析。对每个个体因素进行Cox比例风险回归分析，使用每个因素的所有可用数据估计个体风险比。采用逐步和最佳模型选项来确定作为预测指标的最佳组合，并计算调整后的风险比。根据获得的信息，为每位患者分配一个分类评分以预测复发。用于评分的变量进行了二分法处理。使用对数秩检验评估复发时间评分之间的差异，以比较用Kaplan-Meier方法生成的复发时间曲线。
871例患者纳入研究，中位随访49个月后66例患者出现疾病复发。肿瘤大小、最大浸润深度、盆腔淋巴结状态、肿瘤分级和毛细血管淋巴间隙（CLS）是复发的单一预测指标，基于这些因素组合的评分可预测无病生存期。最大浸润深度、盆腔淋巴结状态和CLS是复发的最佳联合预测指标，它们被用于形成第二个精确的评分系统以预测无病生存期（P < 0.0001；对数秩检验）。
基于最大浸润深度、CLS和盆腔淋巴结转移的评分系统确定了具有不同无复发生存期的四个患者分层。每个因素的逐渐存在会降低患者接受根治性手术后的无复发生存期。存在所有三个因素的患者5年无复发生存率为65%。这些患者适合进行术后辅助治疗研究以改善预后。
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