Kapp D S, Fischer D, Gutierrez E, Kohorn E I, Schwartz P E
Int J Radiat Oncol Biol Phys. 1983 Apr;9(4):445-55. doi: 10.1016/0360-3016(83)90060-3.
From January, 1953 through December, 1977, 910 previously untreated patients with invasive carcinoma of the uterine cervix (Stages IB-IVB) were seen at Yale-New Haven Medical Center and affiliated hospitals. An extensive retrospective analysis was undertaken in an attempt to identify prognostically significant pretreatment factors. The patients studied were uniformly staged according to the current FIGO recommendations and the majority of patients had been treated under standardized protocols combining external beam radiation therapy and intracavitary radium. Pretreatment parameters, including prior medical illnesses, gross tumor characteristics, histology, and blood parameters were studied, employing stepwise Cox regression analyses to identify the possible effects of all factors and all two-way interactions among factors on survival, disease-free survival and freedom from local-regional failure, controlling for stage of disease. FIGO stage, patient age at diagnosis, pretreatment neutrophil count and hematocrit, uterine position, prior subtotal hysterectomy, histology, history of diabetes mellitus and number of pregnancies were all found to have prognostic significance. When other factors including stage of disease were controlled for, increased tumor size was associated with decrease disease-free survival and local-regional control rates.
从1953年1月至1977年12月，耶鲁 - 纽黑文医疗中心及其附属医院共收治了910例先前未经治疗的子宫颈浸润癌患者（分期为IB - IVB期）。进行了广泛的回顾性分析，以确定具有预后意义的预处理因素。所研究的患者均按照国际妇产科联盟（FIGO）的现行建议进行分期，并且大多数患者接受了结合外照射放疗和腔内镭疗的标准化方案治疗。研究了预处理参数，包括既往病史、肿瘤大体特征、组织学和血液参数，采用逐步Cox回归分析来确定所有因素以及因素之间所有双向相互作用对生存、无病生存和局部区域无复发生存的可能影响，并对疾病分期进行了控制。结果发现，FIGO分期、诊断时患者年龄、预处理时的中性粒细胞计数和血细胞比容、子宫位置、既往次全子宫切除术、组织学、糖尿病史和妊娠次数均具有预后意义。当控制包括疾病分期在内的其他因素时，肿瘤大小增加与无病生存率和局部区域控制率降低相关。
