Gerdin E, Cnattingius S, Johnson P, Pettersson B
Department of Obstetrics, University Hospital, Uppsala, Sweden.
Gynecol Oncol. 1994 Jun;53(3):314-9. doi: 10.1006/gyno.1994.1140.
Patients with cervical carcinoma FIGO stage IB and IIA (n = 167) treated with brachytherapy, radical hysterectomy, and pelvic lymphadenectomy at the University Hospital of Uppsala were evaluated, and a multivariate analysis was performed to reveal clinical and histopathological variables of predictive value of recurrence. The 5-year survival rate was 90%. Nineteen patients developed recurrent disease (11%), 15 of whom died. Patient age, clinical stage, type, and histologic grade of tumor did not indicate an increased risk of recurrence. However, multiparity (3 children or more; relative risk, RR = 4.6), lymph node metastases (RR = 6.4), tumor size (RR = 5.1), and residual carcinoma in the hysterectomy specimen (RR = 3.4) were important predictive indicators of recurrence. The median interval from initial treatment to the diagnosis of recurrence was 15 months. The majority of recurrences occurred during the first 2 years after treatment (74%) and most of them had symptoms (84%). Only three patients with recurrence were diagnosed within our surveillance program. The data suggest that surveillance for recurrence can be made more cost efficient with a more individualized follow-up during the first 2 years after treatment, concentrating on the patients with high-risk factors such as large tumors, residual carcinoma after irradiation therapy, and/or lymph node metastases.
对在乌普萨拉大学医院接受近距离放疗、根治性子宫切除术和盆腔淋巴结清扫术治疗的国际妇产科联盟（FIGO）IB期和IIA期宫颈癌患者（n = 167）进行了评估，并进行多变量分析以揭示具有复发预测价值的临床和组织病理学变量。5年生存率为90%。19名患者出现复发性疾病（11%），其中15人死亡。患者年龄、临床分期、肿瘤类型和组织学分级并未显示复发风险增加。然而，多产（3个或更多子女；相对风险，RR = 4.6）、淋巴结转移（RR = 6.4）、肿瘤大小（RR = 5.1）以及子宫切除标本中的残留癌（RR = 3.4）是复发的重要预测指标。从初始治疗到复发诊断的中位间隔时间为15个月。大多数复发发生在治疗后的前2年内（74%），且大多数有症状（84%）。在我们的监测计划中仅诊断出3例复发患者。数据表明，通过在治疗后的前2年进行更个体化的随访，将重点放在具有高危因素的患者身上，如大肿瘤、放疗后残留癌和/或淋巴结转移患者，可使复发监测更具成本效益。
