Brun Jean Luc, Stoven-Camou Dorothée, Trouette Renaud, Lopez Malika, Chene Geneviève, Hocké Claude
Department of Gynecology, University Hospital, Bordeaux, France.
Gynecol Oncol. 2003 Nov;91(2):395-401. doi: 10.1016/s0090-8258(03)00501-8.
We assessed survival and compared clinical and pathological prognostic factors of women with invasive cervical cancer according to the age in order to define a cutoff point where screening should become useless.
The survival of 308 women with invasive cervical cancer treated at Bordeaux University Hospital between 1976 and 1996 was evaluated on December 31, 2000. Kaplan-Meier survival curves calculated with regard to age were compared by the log-rank test. Prognostic factors were assessed according to age (cutoff 65 years) and included in a Cox model. Survival of women in our population within a particular age group was compared to survival of women of the same age range, using indirect standardization.
The 5-year survival rate of women under 65 (n = 221), between 65 and 74 (n = 56), and over 75 (n = 31) was 75%, 69%, 42%, respectively (P < 0.001). Compared to women under 65, women over 65 had a significantly lower Karnofsky performance status and a significantly more advanced clinical stage cancer involving vaginal bleeding. Age, gross cervical appearance, clinical vaginal involvement, histologic grade, and microscopic cervical and parametrial involvements were independent prognostic factors. Compared to women under 65, the risk of mortality was 1.3, 95% CI = 0.8-2.7, P = 0.189, for women aged 65-74, and 2.3, 95% CI = 1.1-3.9, P = 0.022, for women over 75. Mortality of women with invasive cervical cancer was significantly higher than that of women in the general population in the indirect standardization model (SMR = 1.9, 95% CI = 1.5-2.2), except beyond age 75.
Age was a significant prognostic factor in our study and advanced stages were significantly increased after 65. However, survival after 75 was not different from that of the population. These considerations address the question of the maintenance of screening between 65 and 75.
我们根据年龄评估了浸润性宫颈癌女性的生存率，并比较了其临床和病理预后因素，以确定筛查不再有效的年龄分界点。
2000年12月31日评估了1976年至1996年间在波尔多大学医院接受治疗的308例浸润性宫颈癌女性的生存率。通过对数秩检验比较按年龄计算的Kaplan-Meier生存曲线。根据年龄（分界点为65岁）评估预后因素，并纳入Cox模型。使用间接标准化方法，将我们研究人群中特定年龄组女性的生存率与相同年龄范围女性的生存率进行比较。
65岁以下（n = 221）、65至74岁（n = 56）和75岁以上（n = 31）女性的5年生存率分别为75%、69%、42%（P < 0.001）。与65岁以下女性相比，65岁以上女性的卡氏功能状态显著更低，临床分期更高且伴有阴道出血。年龄、宫颈大体外观、临床阴道受累情况、组织学分级以及宫颈和宫旁组织的显微镜下受累情况均为独立的预后因素。与65岁以下女性相比，65至74岁女性的死亡风险为1.3，95%置信区间 = 0.8 - 2.7，P = 0.189；75岁以上女性的死亡风险为2.3，95%置信区间 = 1.1 - 3.9，P = 0.022。在间接标准化模型中，浸润性宫颈癌女性的死亡率显著高于一般人群中的女性（标准化死亡比 = 1.9，95%置信区间 = 1.5 - 2.2），75岁以上人群除外。
年龄是我们研究中的一个重要预后因素，65岁后晚期病例显著增加。然而，75岁后的生存率与总体人群并无差异。这些考量涉及到65至75岁之间筛查的维持问题。
