2018版FIGO分期ⅠA2~ⅡA1期宫颈癌患者的治疗选择和预后分析

Therapeutic options and prognostic analysis for patients with FIGO 2018 stageⅠA2-ⅡA1 cervical cancer

摘要:

目的： 分析宫颈癌临床病理特征和不同手术路径对预后的影响及术后治疗方式的合理选择。方法： 选择2013年1月至2018年9月共217例2018版FIGO分期为ⅠA2~ⅡA1期的宫颈癌患者，除外ⅠB3期。手术路径有开腹及腹腔镜2种，经手术后评估危险因素，术后辅助治疗分为放疗组、化疗组及放化疗联合治疗组，评价疗效及不良反应。结果： 217例患者经腹腔镜手术者122例，经开腹手术者95例，2种手术路径对患者预后的差异分析无统计学意义。术后病理示仅有深肌层浸润者占比48.85%，仅有淋巴脉管间质浸润占比9.22%，有2个中危因素者占比28.57%，有3个中危因素者占比4.61%。有淋巴脉管间质浸润对患者无进展生存时间及总生存有不良影响，是ⅠA2~ⅡA1期宫颈癌的独立预后因素，与无淋巴脉管间质浸润组比较差异具有统计学意义。放疗组、化疗组和放化疗联合治疗组各组间无进展生存时间及总生存的差异无统计学意义。治疗主要不良反应为骨髓抑制，Ⅲ/Ⅳ级骨髓抑制在放化疗组发生率最高，经对症处理后可缓解，无治疗相关性死亡。结论： 推荐放疗作为ⅠA2~ⅡA1期宫颈癌的术后辅助治疗方式。

Abstract:

Objective: To analyze the effect of the clinicopathological features and different surgical approaches on the prognosis of cervical cancer and the choice of appropriate postoperative treatment. Methods: A total of 217 patients with FIGO 2018 stageⅠA2-ⅡA1 cervical cancer, excluding stageⅠB3, admitted to our hospital from January 2013 to September 2018 were selected in this study. There were two surgical approaches: laparotomy and laparoscopy. The risk factors were assessed after surgery. The patients were divided into radiotherapy group, chemotherapy group and chemoradiotherapy group for postoperative adjuvant therapy. The efficacy and adverse reactions are evaluated. Results: Of the 217 patients, 122 underwent laparoscopic surgery and 95 underwent laparotomy, and there was no significant difference in the prognosis between the two surgical approaches. Postoperative pathology showed that only deep stromal invasion accounted for 48.85%, only lymphovascular space invasion accounted for 9.22%, two intermediate risk factors accounted for 28.57%, and three intermediate risk factors accounted for 4.61%.Lymphovascular space invasion had an adverse effect on progression-free survival time and overall survival of patients, and was an independent prognostic factor for stageⅠA2-ⅡA1 cervical cancer, which was significantly different from the group without lymphovascular space invasion. There was no significant difference in progression-free survival time and overall survival among the groups in the radiotherapy, chemotherapy, and chemoradiotherapy groups. The main adverse reaction of treatment was myelosuppression, and gradeⅢ/Ⅳmyelosuppression had the highest incidence in the chemoradiotherapy group. The above adverse reactions were relieved after symptomatic treatment, without treatment-related death. Conclusion: Radiotherapy is recommended as a postoperative adjuvant treatment for stageⅠA2-ⅡA1 cervical cancer.