早期宫颈癌术后并发症Clavien-Dindo/CTCAE分级评估及危险因素分析

Clavien-Dindo/CTCAE classification grading and risk factors analysis of postoperative complications in early cervical cancer

摘要:

目的： 采用Clavien-Dindo/CTCAE并发症分类系统评估早期宫颈癌术后并发症并分析其危险因素。方法： 回顾性分析2008年1月至2015年12月南阳医学高等专科学校第一附属医院412例早期宫颈癌患者的临床资料，排除未手术54例、不符合FIGO分期标准23例、临床资料缺失60例、随访退出27例，最终纳入248例早期宫颈癌患者，患者年龄44.5（25，85）岁，体质指数（body mass index，BMI）22.9（14.6，45）kg/m²，采用Clavien-Dindo/CTCAE分类系统对患者术中、术后进行分级评估，单因素分析患者基线资料，并将P<0.2的变量纳入多因素logistic回归模型确定术中、术后并发症的危险因素。Kaplan-Meier生存曲线分析总体生存率并采用对数秩检验。结果： 术后严重并发症（Clavien-Dindo/CTCAE≥3）31例（14.1%）、非严重并发症120例（48.4%），无并发症97例（39.1%）。多因素logistic回归模型显示，BMI>30 kg/m²是术中并发症的独立危险因素（OR=4.90，95%CI=1.72~20.44，P=0.020）；宫旁浸润（OR=7.39，95%CI=1.37~39.72，P=0.020）、术前放疗（OR=3.98，95%CI=1.29~12.34，P=0.016）是术后严重并发症的独立危险因素。结论： BMI>30 kg/m²是术中并发症发生的独立危险因素，宫旁浸润、术前放疗是术后严重并发症发生的独立危险因素。

Abstract:

Objective: To evaluate the postoperative complication of early cervical cancer and analyze its risk factors by using the Clavien-Dindo/CTCAE complications classification system. Methods: The clinical data of 412 patients with early cervical cancer from the our hospital from January 2008 to December 2015 were retrospectively analyzed, among which 54 were excluded without surgery, 23 did not meet the FIGO staging criteria, 60 clinical data were missed, and 27 withdrew from follow-up. Finally, a total of 248 patients with early cervical cancer were included. The patients were 44.5 (25, 85) years old and had a body mass index (BMI) of 22.9 (14.6, 45) kg/m². The system was used to grade patients during and after surgery. Univariate analysis of patient baseline data was performed. Variables with P<0.2 were included in the multivariate logistic regression model to determine risk factors for intraoperative and postoperative complications. Kaplan-Meier survival curve was used to analyze the overall survival rate and log-rank test was used. Results: There were 31 cases (14.1%) of severe complications (Clavien-Dindo/CTCAETC≥3), 120 cases (48.4%) of non-serious complications, and 97 (39.1%) of no complications. Multivariate logistic regression model showed that BMI>30 kg/m²was an independent risk factor for intraoperative complications (OR=4.90, 95%CI=1.72-20.44, P=0.020). The parauterine invasion (OR=7.39, 95%CI=1.37-39.72, P=0.020), and preoperative radiotherapy (OR=3.98, 95%CI=1.29-12.34, P=0.016) were independent risk factors for serious postoperative complications. Conclusion: BMI>30 kg/m², parauterine invasion and preoperative radiotherapy are independent risk factors for intraoperative and postoperative complications.