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目的 探讨影响ⅠB期和ⅡA期宫颈癌预后的高危因素。方法 1992年 12月～ 2 0 0 1年12月手术治疗的 111例宫颈浸润癌 ,中位年龄 4 0岁。按FIGO(1994 )分期标准 ,ⅠB期 80例 (ⅠB1期和ⅠB2期各 4 0例 ) ,ⅡA期 31例。鳞癌 93例 (83.8% ) ,腺癌 17例 (15 .3% ) ,小细胞癌 1例。 111例患者均采用广泛性子宫切除加以撕剥式为主的盆腔淋巴清扫术 ,术前辅助放疗 74例 (6 6 .7% ) ,术后辅助治疗 2 4例 (2 1.6 % )。生存率统计采用Kaplan Meier方法 ,预后相关因素分析采用Cox模型和 χ2 检验。结果 全组患者 5年生存率为 85 .9% ,其中ⅠB1期为 89.1% ,ⅠB2期为 90 .7% ,ⅡA期为 78.4 %。经单因素分析显示 ,肿瘤大小 (HR =1.4 79,P =0 .15 2 )、肿瘤局部类型 (HR =1.4 4 0 ,P =0 .2 6 4 )、临床分期(HR =1.380 ,P =0 .35 4 )、术前和 (或 )术后辅助治疗 (HR =1.2 10 ,P =0 .4 5 0 )、淋巴结转移 (HR =1.4 32 ,P =0 .5 4 0 )、颈管受侵 (HR =2 .2 4 4 ,P =0 .0 36 )、深肌层浸润 (HR =3.2 95 ,P =0 .0 6 )和多个性伴侣 +合并妊娠 (HR =10 .172 ,P =0 .0 0 0 )与早期宫颈癌预后有关。经多因素分析显示 ,宫颈深肌层浸润和多个性伴侣 +合并妊娠是影响预后的重要因素。结论 宫颈深肌层浸润和多个性伴侣 +合并妊娠与
Objective To investigate the risk factors of prognosis of stage ⅠB and ⅡA cervical cancer. Methods Surgical treatment of 111 cases of cervical invasive carcinoma from December 1992 to December 2001 with a median age of 40 years. According to FIGO (1994) staging criteria, 80 cases were in stage IB (40 cases in stage IB1 and stage IB2), and 31 cases in stage IIA. 93 cases of squamous cell carcinoma (83.8%), 17 cases of adenocarcinoma (15.3%) and 1 case of small cell carcinoma. Totally 111 patients underwent radical hysterectomy with pelvic lymphadenectomy. Preoperative adjuvant radiotherapy was performed in 74 patients (66.7%) and postoperative adjuvant therapy in 24 patients (21.6%). Survival rate was calculated using Kaplan Meier method and Cox regression model and χ2 test were used to analyze the prognostic factors. Results The 5-year survival rate was 85.9% in all patients, of which 89.1% were in stage IB, 90.7% in stage IB, 78.4% in stage IIA. According to univariate analysis, the tumor size (HR = 1.479, P = 0.152), tumor type (HR = 1.440, P = 0.264) (P = 0.455), lymph node metastasis (HR = 1.432, P = 0.00540), neck canal (P> 0.05), preoperative and / or postoperative adjuvant therapy Invasion (HR = 2.244, P = 0.036), deep myometrial invasion (HR = 3.295, P = .0 6) and multiple sexual partners + combined pregnancy (HR = P = 0.0000) and early prognosis of cervical cancer. The multivariate analysis showed that deep cervical myometrial invasion and multiple sexual partners + pregnancy is an important prognostic factor. Conclusions Cervical deep myometrial invasion and multiple sexual partners + combined with pregnancy