【摘要】 目的通过对比ⅡA期各亚分期之间的肿瘤学结局,探讨子宫颈癌FIGO 2018新分期中ⅡA期分期的合理性。方法纳入接受开腹手术的FIGO 2009分期ⅡA期子宫颈癌开腹手术病例,以FIGO 2018新分期标准重新分期,并将淋巴结转移的病例设为ⅢC-ⅡA期。通过KM生存分析和Cox多因素分析比较FIGO 2018标准下ⅡA1/ⅡA2/ⅢC-ⅡA期的5年总生存率(OS)和无瘤生存率(DFS)。结果(1)纳入2004-2018年于47家医院住院治疗的FIGO 2009分期ⅡA期病例共4691例,按照FIGO 2018标准进行重新分期后,ⅡA1/ⅡA2/ⅢC-ⅡA期及无法明确分期的病例分别为2279、962、1213及237例。(2)KM生存分析发现,ⅡA1、ⅡA2期的肿瘤学结局均优于ⅢC-ⅡA期(ⅡA1 vs.ⅡA2 vs.ⅢC-ⅡA:OS:91.9%vs.91.3%vs.72.8%,P<0.001;DFS:87.3%vs.87.2%vs.61.6%,P<0.001),但ⅡA1期与ⅡA2期的OS及DFS差异无统计学意义(OS:P=0.294,DFS:P=0.570)。(3)COX多因素分析得出,ⅢC-ⅡA期是ⅡA1、ⅡA2期病例死亡或死亡/复发的独立危险因素。而ⅡA2期不是影响ⅡA1期病例死亡或死亡/复发的独立危险因素。结论从肿瘤学结局的角度分析,FIGO 2018分期ⅡA1、ⅡA2期肿瘤学结局无差异,但淋巴结转移病例的生存结局明显差于ⅡA1和ⅡA2。更多还原

【Abstract】 Objective To explore the rationality of FIGO 2018 new stage Ⅱ A in cervical cancer by comparing the oncological outcomes of each substage of stage ⅡA.MethodsThe patients with FIGO 2009 stage ⅡA cervical cance rundergoing abdominal surgery were included,and the patients with lymph node metastasis were reset as stage ⅢC-ⅡA based on the FIGO 2018 staging standard.The 5-year OS and DFS of FIGO 2018 stageⅡA1/ⅡA2/ⅢC-ⅡA were compared by KM survival analysis and Cox multivariate analysis.Results (1)A total of 4691 patients with FIGO 2009 stageⅡA were included,who were hospitalized for treatment in 47 hospitals from 2004 to 2018. There were 2279,962,1213 and 237 patients restaged asⅡA1/ⅡA2/Ⅲ C-Ⅱ A and undetermined stage,respectively.(2)KM survival analysis showed that the oncological outcomes of ⅡA1 and ⅡA2 were better than those of ⅢC-ⅡA(ⅡA1 vs.ⅡA2 vs.ⅢC-ⅡA:OS:91.9% vs. 91.3% vs. 72.8%,P<0.001;DFS:87.3% vs. 87.2% vs. 61.6%,P<0.001),but the difference in OS and DFS between ⅡA1 and ⅡA2 was insignificant(OS:P=0.294,DFS:P=0.570).(3)Cox multivariate analysis showed that stage ⅢC-ⅡA was an independent risk factor for death or death/recurrence in patients with stage ⅡA1 or ⅡA2.Stage ⅡA2 was not an independent risk factor for death or death/recurrence in stage Ⅱ A1 patients.Conclusion From the perspective of oncological outcome,there is no difference in the oncological outcome between FIGO 2018 stage ⅡA1 and ⅡA2,but the survival outcome of lymph node metastasis cases is obviously worse than that of ⅡA1 and ⅡA2.更多还原