年轻宫颈癌患者预后因素分析
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摘要
目的:宫颈癌（cervical cancer)是最常见的妇科恶性肿瘤，其发病率在发达国家妇女中位居第三，在发展中国家居首位。近年来随着癌前普查工作的广泛开展，宫颈癌发病率及死亡率明显下降，但宫颈癌发病年龄有年轻化倾向。与中老年宫颈癌患者相比，年轻宫颈癌患者具有独特的临床特点及组织病理学特征。本研究回顾性分析河北医科大学第四医院近4年宫颈癌患者的临床资料，分析比较年轻宫颈癌患者及中老年患者的临床特点以及组织病理学特征，研究各病理因素与年轻宫颈癌预后的关系，从而引起妇科医生对年轻宫颈癌患者的重视，使其得到早期诊断、早期治疗，以达到降低年轻宫颈癌患者发病率及提高其生存率的目的。
方法：选取2008年7月25日~2011年12月16日河北医科大学第四医院妇科收治的经手术治疗后病理确认为宫颈癌临床资料，术后均经病理证实为宫颈癌。将其中年轻宫颈癌患者（≤40岁）124例作为研究组，同时随机选取同期中老年患者（>40岁）124例作为对照组，分析两组患者临床资料，比较其临床表现、宫颈形态、临床分期、病理类型、组织学分级、淋巴结转移率以及脉管瘤栓等方面的差异，并分析各病理因素与年轻宫颈癌预后的关系。
采用SPSS18.0软件包统计处理数据。计数资料应用χ~2检验，分析研究组及对照组之间不同因素的差异。应用Kaplan-Meier法计算生存率，log-rank检验进行单因素分析，Cox回归模型进行多因素分析，P <0.05为有统计学差异。
结果：
1年轻宫颈癌患者与中老年宫颈癌患者中，农村患者分别占67.7%和75.0%，差异无统计学意义（P>0.05）。
2年轻与中老年宫颈癌患者中孕次≥3分别为58.1%和75.8%，产次≥3分别为9.7%和38.7%，差异有统计学意义（P<0.05）；年轻与中老年宫颈癌患者有流产史者分别为70.2%和66.9%，差异无统计学意义（P>0.05）。
3年轻及中老年宫颈癌患者临床表现为接触性出血者分别为67.7%和41.9%，为宫颈肿物者分别为81.5%和66.1%，差异有统计学意义（P<0.05）。
4年轻与中老年患者家属中有癌肿病史者分别为14.5%和8.1%，差异无统计学意义（P>0.05）。
5年轻与中老年宫颈癌患者临床分期为Ⅰ期者分别为79.8%和62.9%，年轻宫颈癌患者临床分期早，差异有统计学意义（P<0.05）。
6年轻与中老年宫颈癌患者淋巴转移率分别为26.6%和16.1%，年轻宫颈癌患者淋巴转移率较高，且差别具有统计学意义（P<0.05）。
7年轻与中老年宫颈癌患者中存在脉管瘤栓者有25.0%、7.3%，年轻组所占比例较高，两组差异有统计学意义（P<0.05）。
8年轻宫颈癌患者与中老年宫颈癌患者在病理类型、肿块大小、宫旁转移、组织学分级、肌层浸润、阴道残端受侵方面差异不明显，无统计学意义（P>0.05）。
9年轻宫颈癌中，淋巴结转移与脉管瘤栓、肌层浸润、阴道残端病变有关。有脉管瘤栓、深肌层浸润、阴道残端受侵者淋巴结转移率较高，差异有统计学意义（P<0.05）。
10单因素分析：淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的相关因素（P<0.05）。有淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变的患者生存率较低。多因素回归分析显示：病理类型、肿块大小、临床分期、组织学分级、肌层浸润、淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变均不是影响年轻宫颈癌预后的独立危险因素（P>0.05）。
结论:
1宫颈癌发病呈年轻化趋势，其原因可能与HPV感染、初次性交年龄较早、性生活紊乱、长期口服避孕药等因素有关。
2年轻宫颈癌患者具有独特的临床表现，以接触性出血为主要症状，体征主要表现为宫颈肿物，但有部分年轻宫颈癌患者临床症状及体征不明显，应予以重视。
3与中老年宫颈癌患者相比，年轻宫颈癌患者病理学特征上主要表现为临床分期较早、淋巴结转移率较高、脉管瘤栓患者比例较高。
4年轻宫颈癌中淋巴结转移与脉管瘤栓、肌层浸润、阴道残端受侵有关。
5淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的危险因素淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的危险因素，但均不是独立危险因素。
6加强女性健康卫生教育，普及宫颈癌前筛查，对宫颈癌患者，做到早期诊断、早期治疗有重要的临床意义。
7年轻宫颈癌的治疗要同时遵循规范化、个体化及人性化原则，以达到延长患者生命、提高患者生活质量的目的。
Objective:Cervical cancer is the most common cancer among womenworldwide. The incidence of cervical cancer is the third in developedcountries,and the first in developing countries.As cervical cancer screeningextensively in recent years,the incidence and mortality of cervical cancer havebeen significantly reduced,but The prevalence trend of the cervical cancertends to be younger.Compare with elderly cervical cancer patients,youngpatients with cervical cancer has a unique clinical characteristics andpathological features. Now review the clinical data of cervical cancer patientsin the Fourth Hospital of Hebei Medical University in the past four years,analyse the differences between young cervical cancer patients and elderlypatients,and study of pathological factors and prognosis of young women withcervical.Young patients with cervical cancer should be paid more attention,andgain early diagnosis and treatment to reduce the incidence and mortality ofcervical cancer.
Methods:Select the clinical data of cervical cancer treated in the FourthHospital of Hebei Medical University from July25,2008to December16,2011.And all of the clinical datas of postoperative pathologic have beenconfirmed for cervical cancer.124patients (≤40years) were selected as studygroup and124patients were selected randomly from patients (>40years) ascontrol group, clinical manifestations,cervical morphology,clinicalstages,pathological types, histological grades,lymph node metastasis rate andvascular tumor emboli were compared between the two groups,and study ofpathological factors and prognosis of young women with cervical.
SPSS18.0software package was used to process statistical data. Adopt χ2test to analyse the enumeration data and the differences between the studygroup and control group. The survival rates were calculated by Kaplan-Meier method.Univariate analysis was estimated by log-rank test. Adopt Coxproportional hazards model for multivariate regression analysis.Statisticaldifferences were indicated by P<0.05.
Results:
1Young cervical cancer patients and elderly patients with cervical cancer inthe place of residence was no significant difference (P>0.05),and they were67.7%,75.0%.
2Young cervical cancer patients and elderly patients with motherhood morethan three times were58.1%,75.8%,and patients with parity more than threetimes were9.7%和38.7%.The differences were statistically significant (P<0.05).History of abortion in young group and elderly group were70.2%and66.9%, and they have no significant difference (P>0.05).
3Young cervical cancer patients had unique clinical manifestations, mainly ascontact vaginal bleeding(67.7%) and cervical tumor(81.5%), there weredifferences in elderly patients with cervical cancer(41.9%,66.1%), and thedifference was statistically significant (P <0.05).
4Cancer history of the families of the two groups accounts for14.5%and8.1%. It was no significant difference (P>0.05).
5Young patients with cervical cancer were mainly on earlier clinical stage,compared with elderly patients,the difference was statistically significant (P<0.05).They were79.8%and62.9%.
6The lymph node metastasis rate of young cervical cancer patients andelderly patients were26.6%,16.1%.And young patients have a higher rate. Thedifference was statistically significant (P <0.05).
7Approximately25.0%of young cervical cancer patients had vascular tumoremboli,and7.3%of elderly patients with cervical cancer had vascular tumoremboli.The difference was statistically significant (P <0.05).
8Young group and older group in the pathological type, tumor size,parametrial metastasis, histological grade,myometrial invasion and vaginalstump invasion had no significant difference (P>0.05).
9Vascular invasion, myometrial invasion, atrophy of the vaginal stump were significantly associated with lymph node metastasis in young women withcervical cancer.Young cervical cancer with vascular invasion, deepmyometrial invasion or vaginal stump invasion had a high rate of lymph nodemetastasis,and the difference was statistically significant (P <0.05).10Univariate analysis: lymph node metastasis, vascular invasion, parametrialinvasion and vaginal stump lesions were significantly associated with youngpatients with cervical cancer(P <0.05).The prognosis of young patients withlymph node metastasis, vascular invasion or parametrial invasion werepoor.Multivariate analysis:pathological type, tumor size, clinical stage,histological grade, myometrial invasion,lymph node metastasis, vascularinvasion, parametrial invasion and vaginal stump lesions were not independentrisk factors.
Conclusions:
1The prevalence trend of the cervical cancer tends to be younger.It may bedue to the infection of HPV,first sexual intercourse age prematurely,sexualdisorders,long-term oral contraceptives and others.
2Young patients with cervical cancer has a unique clinical manifestations,and contact bleeding and cervical tumor is the main symptoms.But there aresome young patients with cervical cancer that clinical symptoms and signs isnot obvious, so attention should be paid.
3Compared with the elderly patients with cervical cancer, the pathologicalfeatures of young patients with cervical cancer is mainly as earlier clinicalstage, a higher rate of lymph node metastasis and vascular invasion.
4Vascular invasion, myometrial invasion, atrophy of the vaginal stump aresignificantly associated with lymph node metastasis in young women withcervical cancer.
5Lymph node metastasis, vascular invasion, parametrial invasion and vaginalstump lesions are significantly associated with young patients with cervicalcancer.Pathological type, tumor size, clinical stage, histological grade,myometrial invasion, lymph node metastasis, vascular invasion, parametrialinvasion and vaginal stump lesions are not independent risk factors in young patients with cervical cancer.
6Strengthen women health and hygiene education,and popularize the cervicalcancer screening for early diagnosis and treatment of cervical cancer.It hasimportant clinical significance.
7The treatment of cervical cancer need to follow the standardized,individualized and humane principles to prolong the lives of patients andimprove the quality of life.
方法：选取2008年7月25日~2011年12月16日河北医科大学第四医院妇科收治的经手术治疗后病理确认为宫颈癌临床资料，术后均经病理证实为宫颈癌。将其中年轻宫颈癌患者（≤40岁）124例作为研究组，同时随机选取同期中老年患者（>40岁）124例作为对照组，分析两组患者临床资料，比较其临床表现、宫颈形态、临床分期、病理类型、组织学分级、淋巴结转移率以及脉管瘤栓等方面的差异，并分析各病理因素与年轻宫颈癌预后的关系。
采用SPSS18.0软件包统计处理数据。计数资料应用χ~2检验，分析研究组及对照组之间不同因素的差异。应用Kaplan-Meier法计算生存率，log-rank检验进行单因素分析，Cox回归模型进行多因素分析，P <0.05为有统计学差异。
结果：
1年轻宫颈癌患者与中老年宫颈癌患者中，农村患者分别占67.7%和75.0%，差异无统计学意义（P>0.05）。
2年轻与中老年宫颈癌患者中孕次≥3分别为58.1%和75.8%，产次≥3分别为9.7%和38.7%，差异有统计学意义（P<0.05）；年轻与中老年宫颈癌患者有流产史者分别为70.2%和66.9%，差异无统计学意义（P>0.05）。
3年轻及中老年宫颈癌患者临床表现为接触性出血者分别为67.7%和41.9%，为宫颈肿物者分别为81.5%和66.1%，差异有统计学意义（P<0.05）。
4年轻与中老年患者家属中有癌肿病史者分别为14.5%和8.1%，差异无统计学意义（P>0.05）。
5年轻与中老年宫颈癌患者临床分期为Ⅰ期者分别为79.8%和62.9%，年轻宫颈癌患者临床分期早，差异有统计学意义（P<0.05）。
6年轻与中老年宫颈癌患者淋巴转移率分别为26.6%和16.1%，年轻宫颈癌患者淋巴转移率较高，且差别具有统计学意义（P<0.05）。
7年轻与中老年宫颈癌患者中存在脉管瘤栓者有25.0%、7.3%，年轻组所占比例较高，两组差异有统计学意义（P<0.05）。
8年轻宫颈癌患者与中老年宫颈癌患者在病理类型、肿块大小、宫旁转移、组织学分级、肌层浸润、阴道残端受侵方面差异不明显，无统计学意义（P>0.05）。
9年轻宫颈癌中，淋巴结转移与脉管瘤栓、肌层浸润、阴道残端病变有关。有脉管瘤栓、深肌层浸润、阴道残端受侵者淋巴结转移率较高，差异有统计学意义（P<0.05）。
10单因素分析：淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的相关因素（P<0.05）。有淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变的患者生存率较低。多因素回归分析显示：病理类型、肿块大小、临床分期、组织学分级、肌层浸润、淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变均不是影响年轻宫颈癌预后的独立危险因素（P>0.05）。
结论:
1宫颈癌发病呈年轻化趋势，其原因可能与HPV感染、初次性交年龄较早、性生活紊乱、长期口服避孕药等因素有关。
2年轻宫颈癌患者具有独特的临床表现，以接触性出血为主要症状，体征主要表现为宫颈肿物，但有部分年轻宫颈癌患者临床症状及体征不明显，应予以重视。
3与中老年宫颈癌患者相比，年轻宫颈癌患者病理学特征上主要表现为临床分期较早、淋巴结转移率较高、脉管瘤栓患者比例较高。
4年轻宫颈癌中淋巴结转移与脉管瘤栓、肌层浸润、阴道残端受侵有关。
5淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的危险因素淋巴结转移、脉管瘤栓、宫旁浸润、阴道残端病变是影响年轻宫颈癌预后的危险因素，但均不是独立危险因素。
6加强女性健康卫生教育，普及宫颈癌前筛查，对宫颈癌患者，做到早期诊断、早期治疗有重要的临床意义。
7年轻宫颈癌的治疗要同时遵循规范化、个体化及人性化原则，以达到延长患者生命、提高患者生活质量的目的。
Objective:Cervical cancer is the most common cancer among womenworldwide. The incidence of cervical cancer is the third in developedcountries,and the first in developing countries.As cervical cancer screeningextensively in recent years,the incidence and mortality of cervical cancer havebeen significantly reduced,but The prevalence trend of the cervical cancertends to be younger.Compare with elderly cervical cancer patients,youngpatients with cervical cancer has a unique clinical characteristics andpathological features. Now review the clinical data of cervical cancer patientsin the Fourth Hospital of Hebei Medical University in the past four years,analyse the differences between young cervical cancer patients and elderlypatients,and study of pathological factors and prognosis of young women withcervical.Young patients with cervical cancer should be paid more attention,andgain early diagnosis and treatment to reduce the incidence and mortality ofcervical cancer.
Methods:Select the clinical data of cervical cancer treated in the FourthHospital of Hebei Medical University from July25,2008to December16,2011.And all of the clinical datas of postoperative pathologic have beenconfirmed for cervical cancer.124patients (≤40years) were selected as studygroup and124patients were selected randomly from patients (>40years) ascontrol group, clinical manifestations,cervical morphology,clinicalstages,pathological types, histological grades,lymph node metastasis rate andvascular tumor emboli were compared between the two groups,and study ofpathological factors and prognosis of young women with cervical.
SPSS18.0software package was used to process statistical data. Adopt χ2test to analyse the enumeration data and the differences between the studygroup and control group. The survival rates were calculated by Kaplan-Meier method.Univariate analysis was estimated by log-rank test. Adopt Coxproportional hazards model for multivariate regression analysis.Statisticaldifferences were indicated by P<0.05.
Results:
1Young cervical cancer patients and elderly patients with cervical cancer inthe place of residence was no significant difference (P>0.05),and they were67.7%,75.0%.
2Young cervical cancer patients and elderly patients with motherhood morethan three times were58.1%,75.8%,and patients with parity more than threetimes were9.7%和38.7%.The differences were statistically significant (P<0.05).History of abortion in young group and elderly group were70.2%and66.9%, and they have no significant difference (P>0.05).
3Young cervical cancer patients had unique clinical manifestations, mainly ascontact vaginal bleeding(67.7%) and cervical tumor(81.5%), there weredifferences in elderly patients with cervical cancer(41.9%,66.1%), and thedifference was statistically significant (P <0.05).
4Cancer history of the families of the two groups accounts for14.5%and8.1%. It was no significant difference (P>0.05).
5Young patients with cervical cancer were mainly on earlier clinical stage,compared with elderly patients,the difference was statistically significant (P<0.05).They were79.8%and62.9%.
6The lymph node metastasis rate of young cervical cancer patients andelderly patients were26.6%,16.1%.And young patients have a higher rate. Thedifference was statistically significant (P <0.05).
7Approximately25.0%of young cervical cancer patients had vascular tumoremboli,and7.3%of elderly patients with cervical cancer had vascular tumoremboli.The difference was statistically significant (P <0.05).
8Young group and older group in the pathological type, tumor size,parametrial metastasis, histological grade,myometrial invasion and vaginalstump invasion had no significant difference (P>0.05).
9Vascular invasion, myometrial invasion, atrophy of the vaginal stump were significantly associated with lymph node metastasis in young women withcervical cancer.Young cervical cancer with vascular invasion, deepmyometrial invasion or vaginal stump invasion had a high rate of lymph nodemetastasis,and the difference was statistically significant (P <0.05).10Univariate analysis: lymph node metastasis, vascular invasion, parametrialinvasion and vaginal stump lesions were significantly associated with youngpatients with cervical cancer(P <0.05).The prognosis of young patients withlymph node metastasis, vascular invasion or parametrial invasion werepoor.Multivariate analysis:pathological type, tumor size, clinical stage,histological grade, myometrial invasion,lymph node metastasis, vascularinvasion, parametrial invasion and vaginal stump lesions were not independentrisk factors.
Conclusions:
1The prevalence trend of the cervical cancer tends to be younger.It may bedue to the infection of HPV,first sexual intercourse age prematurely,sexualdisorders,long-term oral contraceptives and others.
2Young patients with cervical cancer has a unique clinical manifestations,and contact bleeding and cervical tumor is the main symptoms.But there aresome young patients with cervical cancer that clinical symptoms and signs isnot obvious, so attention should be paid.
3Compared with the elderly patients with cervical cancer, the pathologicalfeatures of young patients with cervical cancer is mainly as earlier clinicalstage, a higher rate of lymph node metastasis and vascular invasion.
4Vascular invasion, myometrial invasion, atrophy of the vaginal stump aresignificantly associated with lymph node metastasis in young women withcervical cancer.
5Lymph node metastasis, vascular invasion, parametrial invasion and vaginalstump lesions are significantly associated with young patients with cervicalcancer.Pathological type, tumor size, clinical stage, histological grade,myometrial invasion, lymph node metastasis, vascular invasion, parametrialinvasion and vaginal stump lesions are not independent risk factors in young patients with cervical cancer.
6Strengthen women health and hygiene education,and popularize the cervicalcancer screening for early diagnosis and treatment of cervical cancer.It hasimportant clinical significance.
7The treatment of cervical cancer need to follow the standardized,individualized and humane principles to prolong the lives of patients andimprove the quality of life.
引文
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