James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA.
Oncol Rep. 2010 Aug;24(2):511-20. doi: 10.3892/or_00000887.
The purpose of this study was to investigate the prognostic factors, such as clinical, histological and socio-demographic features affecting the event-free and overall survival of the patients with stage I-III carcinoma of the cervix. Eighty-nine patients with International FIGO stage I-III cervical cancer were treated radiation therapy and follow-up of 5-7 years were analyzed for various clinical, histopathological and socio-demographic factors influencing prognosis. Survival estimations were performed using the Kaplan-Meier method, and were compared using the un-weighted log-rank test and multivariable analysis using the Cox proportional hazards model. The median age was 46 years (range, 28-65 years). The 5-year event-free survival (EFS) and overall survival (OAS), along with standard error (SE), were 65.2% (7.0%) and 81.4% (6.1%), respectively. Significant prognostic factors for EFS include, stage (P=0.019), pelvic lymph node metastasis (P=0.013), parametrial (PMT) involvement (P=0.025), number of parametria involved (P=0.000) and tumor size (P=0.034). However, number of parametrial invasion was only significant prognostic factors for overall survival (P=0.015); 5-year survival rate was significantly lower in patients with both PMT involved (58%) than with one PMT involved (>85%). Using a multivariable analysis, we found that number of PMT involved being the only independent significant factor for the development of recurrent disease. None of the socio-demographic factors analyzed were of prognostic importance on event-free and overall survival in cervical cancer patients. Several clinicopathological factors were of prognostic significance but none of the socio-demographic factors analyzed had any role in determining patient outcome. Hence, in cervical cancer, prognosis is more likely dependent on clinical than socio-demographic factors unlike several other cancers where their significant role is well documented. Study of clinical and demographic characteristics for their influence on patient survival could help design better patient management strategies.
本研究旨在探讨影响 I 期-III 期宫颈癌患者无事件生存和总生存的预后因素，包括临床、组织学和社会人口学特征。对 89 例国际妇产科联合会（FIGO）I 期-III 期宫颈癌患者进行放射治疗，并随访 5-7 年，分析各种临床、组织病理学和社会人口学因素对预后的影响。采用 Kaplan-Meier 法进行生存估计，采用非加权对数秩检验和 Cox 比例风险模型多变量分析进行比较。中位年龄为 46 岁（范围 28-65 岁）。5 年无事件生存率（EFS）和总生存率（OAS）分别为 65.2%（7.0%）和 81.4%（6.1%）。EFS 的显著预后因素包括分期（P=0.019）、盆腔淋巴结转移（P=0.013）、宫旁组织（PMT）受累（P=0.025）、受累 PMT 数（P=0.000）和肿瘤大小（P=0.034）。然而，只有 PMT 受累数是总生存的独立预后因素（P=0.015）；PMT 均受累的患者 5 年生存率明显低于仅一侧 PMT 受累的患者（58%比>85%）。多变量分析发现，PMT 受累数是唯一独立的复发疾病发生的显著因素。分析的社会人口学因素均与宫颈癌患者的无事件生存和总生存无关。有几个临床病理因素具有预后意义，但分析的社会人口学因素在确定患者结局方面没有任何作用。因此，与其他几种癌症相比，宫颈癌的预后更可能取决于临床因素而不是社会人口学因素，后者的重要作用已有充分记录。研究临床和人口统计学特征对患者生存的影响有助于设计更好的患者管理策略。
