宫颈癌ⅢC期预后影响因素及亚分期合理性分析

倪芳芳; 李玉芝; 刘红丽; 王玲玲

doi:10.16766/j.cnki.issn.1674-4152.004080

宫颈癌ⅢC期预后影响因素及亚分期合理性分析

doi: 10.16766/j.cnki.issn.1674-4152.004080

蚌埠医科大学第一附属医院妇产科，安徽蚌埠 233004

基金项目:

安徽高校自然科学重点研究项目 KJ2021A0754

详细信息

通讯作者:
李玉芝，E-mail: liyuzhi0518@sina.com

中图分类号: R737.33 R730.7
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出版历程
- 收稿日期: 2025-02-11
- 网络出版日期: 2025-10-25

Analysis of prognosis factors and prognosis of cervical cancer

Department of Obstetrics and Gynecology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨FIGO 2018宫颈癌新分期系统中ⅢC期不同亚分期的预后及影响ⅢC期预后的因素。方法收集蚌埠医科大学第一附属医院2015年1月—2018年1月行宫颈癌根治术的Ⅰ~Ⅱ期517例患者的病历资料，并按照2018版FIGO宫颈癌分期重新进行分期，比较重新分期后的Ⅰ期、Ⅱ期、ⅢC-r期、ⅢC-p期、ⅢC-rp期的5年生存率及5年复发率，并对ⅢC期患者预后的影响因素进行单因素及多因素分析。结果 ⅢC-r期(96.84%)与Ⅰ期(98.99%)和Ⅱ期(96.58%)宫颈癌的5年总生存率差异无统计学意义，与宫颈癌分期越高预后越差这一原则相违背。不同肿瘤大小、转移淋巴结数目、阴道穹隆受累情况、转移淋巴结位置的经病理学确诊的ⅢC期患者(ⅢC-p+ⅢC-rp期)5年生存率和复发率差异均有统计学意义(P＜0.05)。将单因素分析差异有统计学意义的因素纳入Cox比例风险回归模型进行分析，结果显示，阴道穹隆是否受累、转移淋巴结数目是宫颈癌预后的独立影响因素。结论从患者预后角度分析，FIGO 2018宫颈癌的5年总生存率ⅢC-r期与Ⅰ期和Ⅱ期的结局相当，但ⅢC-p期及ⅢC-rp期肿瘤学结局明显差于ⅢC-r期，与宫颈癌分期越高预后越差这一原则相违背。ⅢC期患者的预后存在较大差异性，其生存结局受肿瘤大小、阴道穹隆受累情况、转移淋巴结数目及其位置等因素影响，而阴道穹隆受累、转移淋巴结数目≥2枚是宫颈癌ⅢC期预后的独立危险因素。
- 宫颈癌 /
- 分期 /
- 预后 /
- 肿瘤学结局
Abstract: Objective To investigate the prognosis of different substages of stage ⅢC in the new staging system of cervical cancer in FIGO 2018 and its influencing factors affecting the prognosis of stage ⅢC. Methods The medical records of patients with stage Ⅰ-Ⅱ radical cervical cancer resection from January 2015 to December 2017 in the First Affiliated Hospital of Bengbu Medical University were collected, and the five-year survival rate and five-year recurrence rate of stage Ⅰ, stage Ⅱ, stage ⅢC-r, stage ⅢC-p, and stage ⅢC-rp after re-staging were compared. Univariate and multivariate analyses were performed on the influencing factors of the prognosis of stage ⅢC patients. Results There was no significant difference in the 5-year overall survival rate of cervical cancer between stage ⅢC-r (96.84%) and stage Ⅰ (98.98%) and stage Ⅱ (96.58%, P>0.05), which was contrary to the principle that the higher the stage of cervical cancer, the worse the prognosis. There were significant differences in tumor size, number of metastatic lymph nodes, vaginal vault involvement, location of metastatic lymph nodes, 5-year survival rate and recurrence rate in pathologically confirmed patients with stage ⅢC (ⅢC -p + ⅢC-rp stage, P < 0.05). The influencing factors related to univariate analysis were included in the Cox proportional hazards regression model for data processing, and the results suggested that whether the vaginal vault was involved and the number of lymph nodes metastases were independent risk factors for the prognosis of cervical cancer. Conclusion From the perspective of patient prognosis, the 5-year overall survival rate of cervical cancer in FIGO 2018 is comparable to that of stage ⅢC-r and stage Ⅱ, but the oncological outcomes of stage ⅢC-p and stage ⅢC-rp are significantly worse than those of stage ⅢC-r. It is contrary to the principle that the higher the stage of cervical cancer, the worse the prognosis. The prognosis of stage ⅢC patients is quite different, and their survival outcome is affected by factors such as tumor size, vaginal vault involvement, number and location of metastatic lymph nodes, and whether vaginal vault is involved and the number of metastatic lymph nodes are independent risk factors for the prognosis of stage ⅢC cervical cancer.
- Cervical cancer /
- Staging /
- Prognosis /
- Oncology outcome

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表 1 不同分期宫颈癌5年生存率及复发率[例(%)]

Table 1. Comparison of 5-year survival rate and recurrence rate of cervical cancer in different stages [cases(%)]

项目	Ⅰ期(n=198)	Ⅱ期(n=117)	ⅢC-r期(n=95)	ⅢC-p期(n=64)	ⅢC-rp期(n=43)
5年生存	196(98.99)	113(96.58)	92(96.84)	52(81.25)	33(76.74)
5年复发	8(4.04)	11(9.40)	8(8.42)	19(29.69)	19(44.19)

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表 2 宫颈癌ⅢC期预后影响因素单因素分析

Table 2. Univariate analysis of prognostic factors in patients with stage ⅢC cervical cance

项目	例数	5年生存[例(%)]	χ²值	P值	5年复发[例(%)]	χ²值	P值
肿瘤大小			6.628	0.036		8.209	0.016
＜2 cm	18	17(94.44)			4(22.22)
2~＜4 cm	40	34(85.00)			10(25.00)
≥4 cm	49	34(69.39)			24(48.98)
阴道穹隆受累			20.422	＜0.001		37.790	＜0.001
无	70	61(87.14)			12(17.14)
有	37	24(64.86)			26(70.27)
转移淋巴结数目			7.922	0.005		5.525	0.019
1枚	32	30(93.75)			6(18.75)
≥2枚	75	55(73.33)			32(42.67)
转移淋巴结位置			24.804	＜0.001		131.971	＜0.001
闭孔淋巴结	23	21(91.30)			5(21.74)
盆腔淋巴结	69	57(82.61)			22(31.88)
髂总动脉旁淋巴结	12	6(50.00)			8(66.67)
腹主动脉旁淋巴结	3	1(33.33)			3(100.00)

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表 3 宫颈癌ⅢC期患者预后影响因素的Cox多因素分析

Table 3. Cox multivariate analysis of prognostic factors in patients with stage ⅢC cervical cancer

项目	B	SE	Waldχ²	P值	HR值	95% CI
肿瘤大小
2~＜4 cm	-4.880	1.161	0.177	0.674	0.614	0.063~5.976
≥4 cm	0.714	1.068	0.447	0.504	2.043	0.252~16.558
阴道穹隆受累	2.261	0.603	14.060	＜0.001	9.593	2.942~31.278
转移淋巴结数目≥2枚	2.725	0.820	7.701	0.006	9.728	1.951~48.513
转移淋巴结位置
盆腔淋巴结	0.560	0.787	0.507	0.477	1.751	0.375~8.183
髂总动脉旁淋巴结	0.418	0.851	0.241	0.623	1.518	0.287~8.043
腹主动脉旁淋巴结	0.493	1.061	0.216	0.642	1.638	0.205~13.094
注：以肿瘤大小＜2 cm、无阴道穹隆受累、转移淋巴结数目1枚、转移淋巴结位置为闭孔淋巴结为参照。各变量赋值如下，肿瘤大小＜2 cm=1、2~＜4 cm=2、≥4 cm=3；无阴道穹窿受累=1、有阴道穹窿受累=2；转移淋巴结数目1枚=1、≥2枚=2；有盆腔淋巴结转移=1、髂总动脉旁淋巴结转移=2、腹主动脉旁淋巴结转移=3。

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