Analysis The Postoperative Recurrence And Prognostic Factors Of156Patients With The Cervical Carcinoma

Objective: This study discussed the postoperative recurrence andprognostic of cervical patients who come from our hospital.Analyzed theclinicopathological factors correlate,clinical features and various treatments ofpostoperative recurrence and prognostic. The aim of this study is decrease thepostoperative recurrence of cervical carcinoma,and to provide basis forimprove survival rates and prognostic of cervical carcinoma.Methods: Selected pathologic, history and follow-up data of156patients(according to the2009staging of FIGO) by operation treatmentadmitted to gynecology in the Fourth Affiliated Hospital of Hebei MedicalUniversity between January1,2007and December31,2008.There were22patients recurrence.Statistics the clinical,pathological,and follow-up datas byretrospective analysis.They all in accordance with the following three criteriaFirst,all patients underwent radical operation of cervicalcarcinoma(Extensive hysterectomy+Pelvic lymphadenectomy),and provedby pathology after the operation for cervical cancer; Second,the diagnosis ofrecurrence:Mainly through pathologic diagnosis,the tumor appeared againconfirmed by biopsy and pathologic;for the clinical diagnosis of distant lungmetastasis and bone metastasis are unable to obtain the pathologicaldiagnosis,thus depending on the symptoms,signs and auxiliary examinationdiagnosis; Third, they all have complete medical records and pathologicaldata,they have a relatively complete follow-up data. We chose telephone asthe follow-up method. We followed up regularly when all the treatment wascompleted. We specify December31,2013as the follow-up deadline, the lastfollow-up covered all studies. The survival time of patients means the periodfrom surgical procedure day to last follow-up time or the death of theresearch object. The recurrence time of patients means the period from surgical procedure day to the time of the research object of recurrence.Weanalyzed the clinical data of each patient such as age, clinical stage, the sizeof primary tumor,pathological type, differentiation degree, depth of muscularinvasion, within or without vascular invasion, pelvic lymph node metastasis,treatment modality and evaluated recurrence and survival influencing factors.We used SPSS13.0for statistical analysis, Kaplan-Meier to calculate thesurvival rate, and made use of Log-rank non-parametric test for the relatedfactors of recurrence and survival rate comparison. By the use of COXproportional hazards regression model for multivariate analysis of the factorsthat P values less than0.05. P<0.05represents statistical significance. Thesurvival cases at the final follow-up time, the non-cancer deaths wereprocessed as censored data in statistical analysis.Results:1There were22patients recurrenced in the whole group(156patients).Theoverall recurrence rate was14.10%. Univariate analysis showed that therecurrence rate of the clinical stage earlier group(≤Ⅰb2stage) was lowerthan the late clinical stage group(＞Ⅰb2stage), the difference had statisticalsignificance (χ2=4.395，P=0.036); the recurrence rate of the squamous cellcarcinoma group was lower than other pathological type group, the differencehad statistical significance (χ2=5.409，P=0.020); The patients without vascularinvasion had lower recurrence rate compared with those within vascularinvasion, the difference had statistical significance (χ2=13.824，P=0.000); therecurrence rate of the group without pelvic lymph node metastasis was lowerthan the other group, the difference had statistically significance (χ2=22.455，P=0.000). That means the clinical stage, pathological type,vascular invasion,pelvic lymph node metastasis all influent the postoperative recurrence ofcervical carcinoma. But the age, the size of primary tumor, differentiationdegree,depth of muscular invasion, treatment had no influence on thepostoperative recurrence of cervical carcinoma. Multifactor analysis showedthat vascular invasion was a independent influence to the postoperativerecurrence of cervical carcinoma (P=0.004). 2There were31patients died in the whole group(156patients). The5-yearoverall survival rate was80.13%. Univariate analysis showed that the5-yearsurvival rate of the clinical stage earlier group(≤Ⅰb2stage) was higher thanthe late clinical stage group(＞Ⅰb2stage), the difference had statisticalsignificance (χ2=8.767，P=0.003); the5-year survival rate of the squamouscell carcinoma group was higher than other pathological type group, thedifference had statistical significance (χ2=12.078， P=0.001); the5-yearsurvival rate of the superficial myometrial invasion group was higher thandeep myometrial invasion group, the difference had statistical significance(χ2=4.172，P=0.041);The patients without vascular invasion had higher5-yearsurvival rate compared with those within vascular invasion, the difference hadstatistical significance (χ2=13.824,P=0.000); the5-year survival rate of thegroup without pelvic lymph node metastasis was higher than the other group,the difference had statistically significance (χ2=8.487，P=0.004). But the age,the size of primary tumor, differentiation degree, treatment had no influenceon the prognosis of cervical carcinoma.Multifactor analysis showed thatclinical stage, vascular invasion and pelvic lymph node metastasis wereindependent influences to prognosis of cervical carcinoma (P=0.016,0.043,0.002).Conclusion:1The factors such as clinical stage, pathological type, vascular invasion andpelvic lymph node metastasis had significant impact on the patient’spostoperative recurrence. And vascular invasion was a independent influenceto the postoperative recurrence of cervical carcinoma.2The factors such as clinical stage, pathological type, depth of muscularinvasion,vascular invasion and pelvic lymph node metastasis had significantimpact on the patient’s prognosis. And clinical stage,vascular invasion andpelvic lymph node metastasis were independent influences to the prognosis ofcervical carcinoma.