Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Cancer Care Ontario, Toronto, Ontario, Canada.
J Low Genit Tract Dis. 2021 Jan 1;25(1):9-14. doi: 10.1097/LGT.0000000000000582.
A population-level retrospective cohort study was conducted to determine the influence of cervical screening history on the survival from cervical cancer in women 50 years or older.
The study included women diagnosed with invasive cervical cancer in Ontario, Canada, between 2005 and 2012, who were followed for at least 4 years. Screening history was observed for the 5 years before diagnosis. Health care administrative databases were linked to determine demographic, affiliation with primary care physicians, stage (available 2010-2012), treatment, and survival data. Kaplan-Meier and multivariate analyses were carried out to evaluate the impact of cervical screening on overall survival (OS).
There were eligible 1,422 women diagnosed with invasive cervical cancer between 2005 and 2012 of whom 566 had been screened within the 5 years before diagnosis. There were 856 women who did not undergo screening within the 5 years before diagnosis. Unscreened women were more likely to present with locally advanced disease (69.3%) compared with the screened women (42.9%). Four-year OS was significantly greater in the screened group (79.9% vs 58.2%). In our univariate analysis, screening was significantly related to survival (hazard ratio = 2.1, p < .01). In our multivariate analysis after adjusting for age, treatment, affiliation with a primary care physician, and income, screening was still significantly associated with improved survival (hazard ratio = 1.5, p < .01).
Our results demonstrate a survival benefit to screening in women 50 years or older who are diagnosed with cervical cancer. Screening participation must be encouraged in women older than 50 years as rates decline in this age group.
本研究开展了一项基于人群的回顾性队列研究，旨在确定宫颈筛查史对 50 岁及以上女性宫颈癌生存的影响。
本研究纳入了 2005 年至 2012 年期间在加拿大安大略省诊断为浸润性宫颈癌的女性患者，这些患者的随访时间至少为 4 年。在诊断前的 5 年内观察筛查史。通过链接医疗保健管理数据库来确定人口统计学、与初级保健医生的关联、分期（2010-2012 年可用）、治疗和生存数据。通过 Kaplan-Meier 分析和多变量分析评估宫颈筛查对总生存率（OS）的影响。
在 2005 年至 2012 年期间，符合条件的 1422 名女性被诊断为浸润性宫颈癌，其中 566 名女性在诊断前的 5 年内接受过筛查。856 名女性在诊断前的 5 年内未接受过筛查。未筛查的女性更有可能出现局部晚期疾病（69.3%），而筛查的女性则较少见（42.9%）。筛查组的 4 年 OS 显著更高（79.9%比 58.2%）。在单变量分析中，筛查与生存显著相关（风险比=2.1，p<.01）。在调整年龄、治疗、与初级保健医生的关系和收入后，多变量分析仍显示筛查与生存改善显著相关（风险比=1.5，p<.01）。
我们的研究结果表明，50 岁及以上女性在诊断为宫颈癌时进行筛查可获得生存获益。应鼓励 50 岁以上女性进行筛查，因为该年龄段的筛查率正在下降。
