年轻宫颈癌的临床及预后分析
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摘要
目的:探讨年龄≤35岁年轻宫颈癌的发病相关因素、临床病理特点、影响预后因素及术后生存质量情况。
方法:第一部分:对1999-2007年入住我院的年龄≤35岁的58例年轻宫颈癌患者与>35岁的269例中老年宫颈癌患者临床资料进行回顾性对比分析,探讨年轻宫颈癌的发病相关因素和临床病理特点。
第二部分:对其中115例Ⅰ-Ⅱa期宫颈癌行广泛全子宫切除术加盆腔淋巴结清扫术后患者的临床病理和随访资料,进行生存率比较分析及影响预后的单因素和多因素回顾性分析。
第三部分:应用FACT—CX中文版量表,调查63例宫颈癌患者术后的生存质量(QOL),并运用多重回归分析影响生存质量的因素。
结果:(1)临床病理特点:年轻宫颈癌组中,临床分期原位癌占17.24%,Ⅰ期占53.45%,两者共占70.69%。临床表现主要为接触性阴道出血(63.79%,37/58),脉管内癌栓者16例(16/46,34.78%);盆腔淋巴结转移者15例(15/46,32.61%),与中老年宫颈癌组比较,差异均有显著性(P<0.05)。
(2)影响生存率的临床病理因素:Ⅰ-Ⅱa期宫颈癌根治术后的5年累积生存率82.95% ,年轻组和中老年组的5年累积生存率分别为70.27%和89.31%,两者比较差异有统计学意义(P=0.0386)。COX模型多因素分析表明宫颈肌层浸润程度、脉管累及情况和盆腔淋巴结转移个数是影响早期宫颈癌的独立预后因素。有≥2个高危因素者,术后放或化疗与未治疗者生存率分别为83.33%和16.67%,两者比较,差异有显著性(P<0.05)。
(3)生存质量:年轻组和中老年组,两组生存质量评分比较差异无统计学意义(P=0.277)。年龄、居住地、卵巢移位、文化程度为QOL的主要影响因素。结论:年轻宫颈癌临床分期以早期癌为主。年轻组与中老年组相比,在生存质量上无差别,但生存率比中老年者差,与盆腔淋巴结转移率和脉管浸润程度高有关。有≥2个高危因素者术后辅予放疗和或化疗,可以明显提高生存率,但不一定提高生存质量。应加强宫颈癌防治知识的宣传和宫颈癌筛查的推广,做到早诊断、早治疗。
Objective:To analyse the etiology ,clinical and pathological features,prognostic factors and the quality of life(QOL) of cervical cancer in women under 35 years old.
Methods:Section one : The clinical information of 58 patients under 35 years old were retrospectively analysed ,in control with 269 patients from 36 to 81 years old between 1999 and 2007 in this hospital.So as to investigate the etiology,clinical and pathological features in younger patients.
Section two: The clinicopathologic records of 115 patients with cervical cancer of stageⅠ-ⅡA who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factors were identified by COX proportional hazards regression model.
Section three: The Chinese FACT-CX questionnaire were self-reported by the 63 patients treated by surgery.The influential factors of the quality of life(QOL) were explored by multilple linear regression .
Results: (1)Section one: The disease stage was at 0 andⅠin 70.69% of the younger patient( P < 0.05). In younger group,contact bleeding was the main symptom that occurred in 63.79%(37/ 58),and there are 16 cases with lymph vascular involvement( P < 0.05) .The rate of pelvic lymph metastasis was 32.61 %(15/ 46) ( P < 0.05).
(2)Section two:The 5 year survival rate of stageⅠ-ⅡA was 82.95% .The 5-year survival rate in the younger group and the older group were 70.27% and 89.31% respectively (P=0.0386). COX regression analysis indicated that the depth of tumor infiltration、lymph vascular involvement and the number of the pelvic lymph metastasised were independently prognostic factors. For patients with two risk factor after radical surgery , the survival of patients with adjuvant radiation therapy and chemotherapy or not was 83.33 %, 16.67 %, respectively ( P < 0.05)
(3)Section three:There was no significant in QOL score between younger patients and the older patients. The age ,inhabitancy,ovarian transposition and schooling degree were the main influential factors of QOL.
Conclusions: Early clinical stage was the main characteristic in young patients with cervical carcinoma. In comparison to the older patients with cervical cancer, though the QOL the same,the prognosis was poor in young patients,maybe it was related to higher percentage of the lymph vascular involvement and pelvic lymph node metastasis. Adjuvant treatment may be helpful for patients with 2 or more risk factors after radical surgery,but not for improveing QOL. We should emphasize sexual education and cervical screening to young women.
方法:第一部分:对1999-2007年入住我院的年龄≤35岁的58例年轻宫颈癌患者与>35岁的269例中老年宫颈癌患者临床资料进行回顾性对比分析,探讨年轻宫颈癌的发病相关因素和临床病理特点。
第二部分:对其中115例Ⅰ-Ⅱa期宫颈癌行广泛全子宫切除术加盆腔淋巴结清扫术后患者的临床病理和随访资料,进行生存率比较分析及影响预后的单因素和多因素回顾性分析。
第三部分:应用FACT—CX中文版量表,调查63例宫颈癌患者术后的生存质量(QOL),并运用多重回归分析影响生存质量的因素。
结果:(1)临床病理特点:年轻宫颈癌组中,临床分期原位癌占17.24%,Ⅰ期占53.45%,两者共占70.69%。临床表现主要为接触性阴道出血(63.79%,37/58),脉管内癌栓者16例(16/46,34.78%);盆腔淋巴结转移者15例(15/46,32.61%),与中老年宫颈癌组比较,差异均有显著性(P<0.05)。
(2)影响生存率的临床病理因素:Ⅰ-Ⅱa期宫颈癌根治术后的5年累积生存率82.95% ,年轻组和中老年组的5年累积生存率分别为70.27%和89.31%,两者比较差异有统计学意义(P=0.0386)。COX模型多因素分析表明宫颈肌层浸润程度、脉管累及情况和盆腔淋巴结转移个数是影响早期宫颈癌的独立预后因素。有≥2个高危因素者,术后放或化疗与未治疗者生存率分别为83.33%和16.67%,两者比较,差异有显著性(P<0.05)。
(3)生存质量:年轻组和中老年组,两组生存质量评分比较差异无统计学意义(P=0.277)。年龄、居住地、卵巢移位、文化程度为QOL的主要影响因素。结论:年轻宫颈癌临床分期以早期癌为主。年轻组与中老年组相比,在生存质量上无差别,但生存率比中老年者差,与盆腔淋巴结转移率和脉管浸润程度高有关。有≥2个高危因素者术后辅予放疗和或化疗,可以明显提高生存率,但不一定提高生存质量。应加强宫颈癌防治知识的宣传和宫颈癌筛查的推广,做到早诊断、早治疗。
Objective:To analyse the etiology ,clinical and pathological features,prognostic factors and the quality of life(QOL) of cervical cancer in women under 35 years old.
Methods:Section one : The clinical information of 58 patients under 35 years old were retrospectively analysed ,in control with 269 patients from 36 to 81 years old between 1999 and 2007 in this hospital.So as to investigate the etiology,clinical and pathological features in younger patients.
Section two: The clinicopathologic records of 115 patients with cervical cancer of stageⅠ-ⅡA who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factors were identified by COX proportional hazards regression model.
Section three: The Chinese FACT-CX questionnaire were self-reported by the 63 patients treated by surgery.The influential factors of the quality of life(QOL) were explored by multilple linear regression .
Results: (1)Section one: The disease stage was at 0 andⅠin 70.69% of the younger patient( P < 0.05). In younger group,contact bleeding was the main symptom that occurred in 63.79%(37/ 58),and there are 16 cases with lymph vascular involvement( P < 0.05) .The rate of pelvic lymph metastasis was 32.61 %(15/ 46) ( P < 0.05).
(2)Section two:The 5 year survival rate of stageⅠ-ⅡA was 82.95% .The 5-year survival rate in the younger group and the older group were 70.27% and 89.31% respectively (P=0.0386). COX regression analysis indicated that the depth of tumor infiltration、lymph vascular involvement and the number of the pelvic lymph metastasised were independently prognostic factors. For patients with two risk factor after radical surgery , the survival of patients with adjuvant radiation therapy and chemotherapy or not was 83.33 %, 16.67 %, respectively ( P < 0.05)
(3)Section three:There was no significant in QOL score between younger patients and the older patients. The age ,inhabitancy,ovarian transposition and schooling degree were the main influential factors of QOL.
Conclusions: Early clinical stage was the main characteristic in young patients with cervical carcinoma. In comparison to the older patients with cervical cancer, though the QOL the same,the prognosis was poor in young patients,maybe it was related to higher percentage of the lymph vascular involvement and pelvic lymph node metastasis. Adjuvant treatment may be helpful for patients with 2 or more risk factors after radical surgery,but not for improveing QOL. We should emphasize sexual education and cervical screening to young women.
引文
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[7]万崇华 罗家洪 杨铮等主编 癌症患者生命质量测定与应用[M].科技出版社,2007
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[1]Akiko Ioka, Hideaki Tsukuma, Wakiko Ajiki and Akira Oshima.Influence of Age on Cervical Cancer Survival in Japan[J]. Jpn J Clin Oncol, 2005;35(8)464–469
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[15] Greimel E,Thiel I,Peintinger F,et a1.Prospective assessment of quality of life of female cancer patients[J].Gynecol Oncol,2002,85(1):140-147.
[16]邱红 于世英.205例宫颈癌患者生存质量分析[J],中华物理医学与康复杂志,2004,26(2):103-105
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[20]Kamau RK,Osoti AO,Njuguna EM,Effect of diagnosis and treatment of inoperable cervical cancer on quality of life among women receiving radiotherapy at Kenyatta National Hospital.East Afr Med J.2007 ,84(1):24-30.
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