Chen Lu, Lü Wei-Guo, Xie Xing, Chen Huai-Zeng, Yu Hua, Ni Xing-Hao
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
Zhonghua Fu Chan Ke Za Zhi. 2005 Apr;40(4):239-42.
To analyze the prognostic factors in patients with cervical squamous cell carcinoma of stage Ib and IIa treated by surgery, and to investigate their guide roles in available post-operation adjuvant therapy.
The clinicopathologic records of 306 patients with cervical squamous cell carcinoma of stage Ib and IIa who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factors were identified by COX proportional hazards regression model.
The overall 5-year survival rate of these 306 patients was 78.1%. In univariate survival analysis, the poor prognostic factors included poor differentiation, positive pelvic lymph nodes, deep stromal invasion, parametrial extension, tumor size > or = 4 cm, and lymph vascular space involvement (P < 0.05). While in multivariate survival analysis, the independent prognostic factors included positive pelvic lymph nodes, deep stromal invasion and parametrial extension (P < 0.05). According to the risk factors, all patients were divided into low, intermediate and high risk groups with 5-year survival rate of 90.3%, 83.9% and 43.1%, respectively. In low risk group, no risk factor or only parametrial extension was involved, pelvic recurrence rate was only 2.2%. In intermediate risk group, deep stromal invasion or together with parametrial extension was involved. Pelvic recurrence rate and extra pelvic metastasis rate were 13.5% and 1.3%, respectively. In high risk group, lymph node metastasis or together with other high risk factors was involved, pelvic recurrence rate and extra pelvic metastasis rate were 25.9% and 48.3%, respectively, and 10.3% had both pelvic recurrence and extra pelvic metastasis.
Lymph node metastasis, deep stromal invasion and parametrial extension were independent prognostic factors of stage Ib and IIa cervical squamous cell carcinoma patients undergoing radical hysterectomy and lymphadenectomy. The establishment of prognosis-predicting system based on high risk factors may be helpful to predict the risk of recurrence and metastasis, and guide adjuvant therapy after surgery.
分析Ib期和IIa期宫颈鳞状细胞癌患者手术治疗后的预后因素，并探讨其在术后辅助治疗中的指导作用。
回顾性分析306例行根治性子宫切除术和盆腔淋巴结清扫术的Ib期和IIa期宫颈鳞状细胞癌患者的临床病理记录，采用单因素和多因素方法探讨预后因素。通过COX比例风险回归模型确定独立预后因素。
这306例患者的总体5年生存率为78.1%。单因素生存分析中，预后不良因素包括低分化、盆腔淋巴结阳性、间质深层浸润、宫旁组织受累、肿瘤大小≥4 cm和脉管间隙浸润（P<0.05）。多因素生存分析中，独立预后因素包括盆腔淋巴结阳性、间质深层浸润和宫旁组织受累（P<0.05）。根据危险因素，将所有患者分为低、中、高风险组，5年生存率分别为90.3%、83.9%和43.1%。低风险组无危险因素或仅宫旁组织受累，盆腔复发率仅为2.2%。中风险组间质深层浸润或合并宫旁组织受累，盆腔复发率和盆腔外转移率分别为13.5%和1.3%。高风险组有淋巴结转移或合并其他高危因素，盆腔复发率和盆腔外转移率分别为25.9%和48.3%，10.3%患者同时有盆腔复发和盆腔外转移。
淋巴结转移、间质深层浸润和宫旁组织受累是行根治性子宫切除术和淋巴结清扫术的Ib期和IIa期宫颈鳞状细胞癌患者的独立预后因素。基于高危因素建立的预后预测系统可能有助于预测复发和转移风险，并指导术后辅助治疗。
