Graves Stephen, Seagle Brandon-Luke L, Strohl Anna E, Shahabi Shohreh, Nieves-Neira Wilberto
Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL.
Int J Gynecol Cancer. 2017 Feb;27(2):390-395. doi: 10.1097/IGC.0000000000000884.
To determine overall survival (OS) and factors associated with OS after pelvic exenteration for cervical cancer.
Women with cervical cancer who underwent exenteration (n = 517) were identified from the 1998 to 2011 National Cancer Database. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. Analyzed confounders included age, insurance status, income, distance from home to treatment center, stage, exenteration type, surgical margin status, and treatment with adjuvant radiation and/or chemotherapy.
Among the entire cohort with clinical follow-up (n = 313), median OS was 24 months. Stage (P = 2.5 × 10), lymph node status (P = 1.3 × 10), insurance status (P = 1.5 × 10), and histologic type (P = 0.04) were significantly associated with OS by the log-rank test. Unadjusted median OS was 24.2 and 61.8 months for women with squamous and adenocarcinoma histologies, respectively. By multivariate Cox regression, age, insurance status, stage, margin status, and adjuvant radiation were associated with OS. Histology was not independently associated with OS on multivariate regression. Among women with node-negative disease, median OS was 73.2 months.
Exenteration may be curative for more than half of women with node-negative cervical cancer. Stage, insurance status, lymph node status, and surgical margin are independently associated with differential OS after exenteration.
确定宫颈癌盆腔脏器清除术后的总生存期（OS）以及与OS相关的因素。
从1998年至2011年国家癌症数据库中识别出接受盆腔脏器清除术的宫颈癌女性患者（n = 517）。采用Kaplan-Meier法和多变量Cox比例风险生存分析来检验潜在解释变量与OS之间的关联。分析的混杂因素包括年龄、保险状况、收入、住所至治疗中心的距离、分期、盆腔脏器清除术类型、手术切缘状态以及辅助放疗和/或化疗情况。
在有临床随访的整个队列（n = 313）中，中位OS为24个月。通过对数秩检验，分期（P = 2.5×10）、淋巴结状态（P = 1.3×10）、保险状况（P = 1.5×10）和组织学类型（P = 0.04）与OS显著相关。鳞状细胞癌和腺癌组织学类型的女性患者，未经调整的中位OS分别为24.2个月和61.8个月。通过多变量Cox回归分析，年龄、保险状况、分期、切缘状态和辅助放疗与OS相关。在多变量回归中，组织学类型与OS无独立相关性。在淋巴结阴性疾病的女性患者中，中位OS为73.2个月。
盆腔脏器清除术可能治愈超过一半的淋巴结阴性宫颈癌女性患者。分期、保险状况、淋巴结状态和手术切缘与盆腔脏器清除术后的OS差异独立相关。
