2005-2013 年丹麦宫颈癌妇女的复发风险、预后和随访：一项全国队列研究。

Risk of recurrence, prognosis, and follow-up for Danish women with cervical cancer in 2005-2013: A national cohort study.

机构信息

Department of Oncology, Rigshospitalet, Copenhagen, Denmark.

Department of Pathology, Herlev Hospital, Herlev, Denmark.

出版信息

Cancer. 2018 Mar 1;124(5):943-951. doi: 10.1002/cncr.31165. Epub 2017 Dec 6.

DOI:10.1002/cncr.31165

PMID:29211304

Abstract

BACKGROUND

In developed countries, women attend follow-up after treatment for cervical cancer to detect recurrence. The aim of this study was to describe the Danish population of women with early-stage cervical cancer at risk for recurrence and death due to recurrence.

METHODS

Data were extracted from 3 nationwide databases to find women diagnosed with stage 1A1 to 1B1 cervical cancer in 2005-2013. Recurrences were determined from data on oncological or surgical treatment more than 3 months after the initial diagnosis and were cross-checked with patient journals.

RESULTS

In all, 1523 patients were diagnosed with stage 1A1 to 1B1 cervical cancer. Eighty women experienced recurrences: 8 at International Federation of Gynecology and Obstetrics (FIGO) stage 1A1, 0 at FIGO stage 1A2, and 72 at FIGO stage 1B1. The 5-year recurrence rate was 6.4%; 67.5% of the women had symptomatic recurrences, and 28.8% had asymptomatic recurrences. At significantly greater risk for recurrence were women at stage 1B1, regardless of their lymph node (LN) status at diagnosis (hazard ratio with a positive LN, 5.10; 95% confidence interval [CI], 1.65-15.76; P = .0047; hazard ratio with a negative LN, 3.14; 95% CI, 1.25-7.93; P = .0153; hazard ratio with LN data missing, 6.33; 95% CI, 1.80-22.26; P = .004), women older than 50 years (hazard ratio, 1.81; 95% CI, 1.12-2.94; P = .0158), and women with lymphatic and lymphovascular space invasion (LVSI; hazard ratio, 1.92; 95% CI, 1.11-3.30; P = .0188). In a multivariate analysis, significantly inferior survival was found after recurrence for patients with lymphatic LVSI (hazard ratio, 2.23; 95% CI, 1.04-4.80; P = .0401), a symptomatic diagnosis of recurrence (hazard ratio, 2.52; 95% CI, 1.08-5.90; P = .0332), and multiple sites of recurrence (hazard ratio, 2.72; 95% CI, 1.32-5.61; P = .0066).

CONCLUSIONS

This study has identified a group of women at FIGO stage 1A1 in no need of specialized, hospital-based follow-up. Many of the recurrences at FIGO stage 1B1 are asymptomatic, and this may show a need for follow-up in this group. Further prospective investigation is needed. Cancer 2018;124:943-51. © 2017 American Cancer Society.

摘要

背景

在发达国家，女性在接受宫颈癌治疗后会进行随访，以检测复发情况。本研究旨在描述丹麦有早期宫颈癌且有复发风险和因复发而死亡风险的女性人群。

方法

从 3 个全国性数据库中提取数据，以确定在 2005 年至 2013 年期间诊断为 1A1 期至 1B1 期宫颈癌的女性。复发是通过初始诊断后 3 个月以上的肿瘤或手术治疗数据确定的，并与患者病历进行交叉核对。

结果

共诊断出 1523 例 1A1 期至 1B1 期宫颈癌患者。80 例患者出现复发：8 例国际妇产科联合会（FIGO）分期 1A1 期，0 例 FIGO 分期 1A2 期，72 例 FIGO 分期 1B1 期。5 年复发率为 6.4%；67.5%的患者有症状性复发，28.8%的患者为无症状性复发。有更高复发风险的是 1B1 期的女性，无论其淋巴结（LN）状态如何（阳性 LN 时的危险比为 5.10；95%置信区间 [CI]，1.65-15.76；P=.0047；阴性 LN 时的危险比为 3.14；95%CI，1.25-7.93；P=.0153；LN 数据缺失时的危险比为 6.33；95%CI，1.80-22.26；P=.004），年龄大于 50 岁的女性（危险比为 1.81；95%CI，1.12-2.94；P=.0158）和有淋巴血管空间侵犯（LVSI）的女性（危险比为 1.92；95%CI，1.11-3.30；P=.0188）。多变量分析显示，有 LVSI 淋巴受累的患者在复发后生存明显较差（危险比为 2.23；95%CI，1.04-4.80；P=.0401），症状性诊断为复发（危险比为 2.52；95%CI，1.08-5.90；P=.0332），以及多处复发（危险比为 2.72；95%CI，1.32-5.61；P=.0066）。