Research On Influencing Factors Of Prognosis And Quality Of Life In Patients With Cervical Cancer After Surgery

ObjectiveThis research was based on the cervical cancer cohort to grasp the prognostic status and its influencing factors of postoperative patients,and to analyze the key factors in the measurement data and the dose-prognosis relationship,so as to provide reference for the prevention and treatment of cervical cancer after surgery.At the same time,this research was carried out a survey on the quality of life(QOL)of patients on the basis of the previous stage of cohort,in order to evaluate the current level of postoperative patients and explore influencing factors,so as to provide a theoretical basis for the formulation of measures to improve the quality of life of patients.Methods1.This research used a ambispective cohort study design approach,and based on the cervical cancer cohort of a hospital in Guangzhou from 2011 to 2021.The sociodemographic characteristics,pathological characteristics,treatment conditions,laboratory results of the patients were collected,and the postoperative clinical outcomes of the patients were prospectively followed up through outpatient clinics,hospitalizations,and telephone calls.A total of 2008 patients participated in the study,and the latest follow-up work was completed in January2022.Univariate analysis was performed by Chi-square test and Wilcoxon rank sum test to screen sociodemographic,pathological characteristics,treatment status,and laboratory results and other factors that were significant for progression and death.The effects of these factors on the prognosis of patients were comprehensively explored through COX proportional hazards regression model.According to the analysis results,a restricted cubic spline model(RCS)was used to fit the dose-response relationship between the key variables in the measurement data and prognosis.2.Combined with the analysis results of prognostic factors,this research further used the SF-12v2 questionnaire and the general health questionnaire to carry out the QOL survey of postoperative patients in the follow-up work.Aim to understand the patient’s health-related behavioral characteristics,and evaluate the postoperative QOL through the patient’s physical component summary(PCS)and Mental component summary(MCS).ANOVA,t test,correlation analysis,and Kruskal-Wallis H test were used to analyze the effect of each variable on QOL.And the GLM was used to explore the influencing factors of postoperative patients’ QOL,and then the influence path and effect of each variable were comprehensively analyzed by constructing SEM.Results1.Current prognosis status and influencing factors of postoperative patients with cervical cancerTotal of 1340 patients who met the inclusion and exclusion criteria were included.The median follow-up time of patients was 3.84(2.54~5.27)years.(1)Postoperative prognosis of patients: The overall progression rate of patients was 88.73% and the overall survival rate was 93.66%,5-year progression-free rate was 83.87%,and the 5-year survival rate was89.58%.About 31.19% of the patients had postoperative complications,and the top three complications were lymphocyst(15.90%),lymphedema(13.36%)and ureteral injury(2.91%).The main complications of laparoscopic surgery were ureteral injury,while the main complications of laparotomy were lymphocyst and lymphedema.(2)Univariate analysis results show that: The factors influencing the prognosis with progression or death included: age at diagnosis,medical insurance,employment status,education level,family history,cardiovascular and cerebrovascular diseases,parity,menopausal status,FIGO stage,pathological type,and degree of histological differentiation,vegetation diameter,pelvic lymph node positive,para-aortic lymph node positive,vascular invasion,cervical body junction invasion,cervical myometrial invasion,parametrial invasion,fornix involvement,positive vaginal margins,ovarian metastasis,surgical approach,preoperative P16/Ki67,CPR,FPR,postoperative lymphedema.Also:(1)The overall5-year survival rate and progression-free rate of patients undergoing laparotomy were lower than those undergoing laparoscopy(5-year progression free rate: 82.89% vs 86.67%;5-year survival rate: 87.92% vs94.29%),and the incidence of postoperative complications was higher(32.75% vs 26.25%).Although the number of pelvic lymphatic dissection was significantly higher in patients undergoing laparotomy than in patients undergoing laparoscopy(P<0.001),there was no statistical difference in the rate of postoperative wound closure between the two groups.(2)Preoperative P16 / Ki67 was associated with age of diagnosis,degree of histological differentiation and vascular infiltration(P<0.050),but not related to pathological type,FIGO stage and tumor diameter.With the increase of P16/Ki67 positive degree,the rate of progression,mortality and vascular invasion were increased(P<0.050).(3)Multivariate analysis: According the COX regression model,Vegetation diameter ≥ 4(cm)[Progress HR =1.60,95% CI:(1.13~2.28);Death HR =2.04,95% CI:(1.26~3.32)],cervical myometrial invasion ≥2/3 [Progress HR =1.96,95% CI:(1.34~2.85);Death HR =2.28,95% CI:(1.42~3.64)],other pathological types such as small cell carcinoma and clear cell carcinoma [Progress HR =3.39,95% CI:(1.80~6.39);Death HR=5.50,95% CI:(2.68~11.29)],later FIGO staging [Progress HR =1.78,95% CI:(1.24~2.55);Death HR =1.61,95% CI:(1.03~2.57)],parametrial positivity [Progress HR=1.81,95% CI:(1.03~3.16)],vaginal stump involvement [Progress HR =2.26,95% CI:(1.13~4.51)],vascular invasion [Death HR =2.25,95% CI:(1.37~3.70)],vaginal Fornix involvement [Death HR =1.72,95% CI:(1.09~3.40)],CPR ≥2.69[Progress HR =4.34,95% CI:(2.70~6.99);Death HR =1.93,95% CI:(1.09~3.40)],FPR ≥14.72 [Progress HR =1.93,95% CI:(1.38~2.71);Death HR=3.01,95% CI:(1.90~4.75)],P16/Ki67 double positive[Progress HR=3.64,95% CI:(1.74~7.63)],and poor surgical wound closure [Progress HR=4.06,95% CI:(1.28~12.89)] were independent risk factors for poor prognosis(P<0.050).There was no significant difference in the overall prognosis between patients with squamous cell carcinoma and adenocarcinoma,laparotomy and laparoscopy(P>0.050).(4)Dose-response relationship analysis: There were pathological variables adjusted the RCS,it suggested that there was a non-linear dose-response relationship between CPR,FPR and prognosis(P <0.050).(5)Subgroup analysis: In the stage I~IIA,P16/Ki67 double positive [Progress HR=3.41,95% CI:(1.24~9.37)],laparoscopy [Progress HR=1.75,95% CI:(1.03~2.96)] were patients risk factors for poor prognosis;In the stage IIB~IV,there was no significant difference in the prognosis of the two surgical approaches,but P16/Ki67 double positivity remained a risk factor for tumor progression [Progress HR=3.54,95% CI:(1.21~10.40)](P<0.050).2.Current status of quality of life and its influencing factors of postoperative patients with cervical cancerA total of 712 valid questionnaires with complete data were collected,and the effective rate was 98.49%.(1)Overall QOL of postoperative patients: The PCS of patients with cervical cancer after surgery was(50.00±9.04)score,and the MCS was(50.00±9.53)score.Among the 8 dimensions,the poor top four were general health(64.71±25.41),vitality status(78.23±26.52),psychological status(78.90±20.45)and physical pain(79.46±19.72)score.(2)Distribution of patients’ QOL among variables: The higher education level,the higher PCS(rs =0.145);The MCS of patients with shift work was significantly lower than that of patients without shift experience,and the frequency of exercise was significantly reduced(P<0.050).Patients with less than 5 hours of sleep per day or with sleep problems had the lowest levels of PCS and MCS;The QOL of patients with tumor recurrence and metastasis was significantly reduced(P<0.050).LSD pairwise comparison and correlation analysis showed that:(1)The PCS of patients undergoing laparoscopy or conization was significantly higher than that of patients undergoing laparotomy(P<0.050),and there was no no significant differences between conization and laparoscopy(P>0.050).The same is true for patients with squamous cell carcinoma and adenocarcinoma.(2)Patients with adnexectomy had lower PCS,and perimenopausal patients had the lowest levels of QOL.(3)In terms of health-related behavioral factors,patients who sat for more than 8 hours a day had the worst QOL.With the increase of exercise intensity and weekly exercise frequency,the QOL was higher(P<0.050).Patients who exercised at moderate intensity one to three times a week had the highest PCS;(4)The better the appetite,the higher the monthly household income,the higher the level of MCS(P<0.050).The MCS of the patients were the highest,whose daily eating habits were light diet with less oil and less salt.(3)Multivariate analysis: According to the GLM,the influencing factors of quality of life of patients included: age at diagnosis(PCS:β=-2.26),FIGO stage(PCS:β=-1.53),vegetation diameter(PCS:β=-1.82),surgical method(PCS: laparoscopy β=3.26,conization β=1.81),lymphedema(PCS: β=-1.68),adnexectomy(MCS: β=-3.37),metastasis(The β values of PCS and MCS were-2.88 and-5.38,respectively),poor wound closure(MCS: β=-13.45),sitting time(PCS: β=-2.15;MCS:β=-2.66),Sleep snoring/intermediate awakening ≥ 2 times(PCS: β=-2.69; MCS: β=-2.27),Difficulty falling asleep/waking up early(PCS: β=-2.87),sleep time(MCS: β values for 5-8 hours and ≥ 8 hours were 4.20 and5.87,respectively),appetite(PCS: β values of average appetite and good appetite were 11.58 and 13.87;MCS: β values of normal appetite and good appetite were 10.64 and 11.50,respectively),weekly exercise frequency(MCS: β values for 1~3 times and ≥ 3 times were 3.41 and1.72,respectively),exercise intensity(PCS: β values of low intensity,medium intensity,and high intensity were 4.92,6.08,and 4.87,respectively),per capita monthly household income(MCS: β values of5000~10000 and ≥ 10000 were 1.55 and 4.24,respectively).(4)Comprehensive analysis: According to the structural equation model analysis,it was found that treatment and postoperative conditions were the main factors affecting the QOL.Both treatment and postoperative conditions directly affected physical health(effect value was 0.297,-0.338),treatment conditions indirectly affected mental health(effect value was 0.274),and postoperative conditions had both direct and indirect effects on mental health(total effect value was-0.449).Pathological characteristics had direct effects on treatment conditions,postoperative conditions,and mental health(effect values were-0.596,0.199,and 0.089,respectively),while indirectly affecting physical health(effect value was 0.297);Basic situation indirectly affects the psychological and physical health(effect value were-0.094,-0.086);Exercise directly affects postoperative physical health and indirectly affects mental health(effect values were 0.139,0.128).Conclusions(1)The overall 5-year progression-free rate of patients with cervical cancer after surgery was 83.87%,and the 5-year survival rate was 89.58%.In addition to the pathological features,double-positive P16/Ki67,FPR≥14.72 and CPR ≥2.69 were independent risk factors,and there were nonlinear dose-response relationship between preoperative FPR,CPR and prognosis.Although there was no significant difference in the overall prognosis of patients with different surgery,laparoscopy was still an independent risk factor for poor prognosis in I ~ IIA.(2)The QOL of patients with cervical cancer after surgery was low,which has so many influencing factors,and the treatment and postoperative conditions were the main factors.Adjusting the treatment,reducing the incidence of complications,shortening the duration of sitting,maintaining exercise,strengthening healthy education,improving sleep problems and light diet can improve the QOL.