| Objective:307 cases of patients who underwent radical surgery for stageⅠB-ⅡA cervical squamous cell carcinoma were retrospectively followed and analyzed the clinical features, pathological, treatments, prognosis and relapses. Lymph node metastasis is accepted established as the prognosis factor of cervical squamous cell carcinoma which is also analyzed the relationship with other factors. The aim of this study is to provide basis for improving survival rates and prognostic of cervical carcinoma.Methods: A retrospective analysis and a follow-up of 307 patients with FIGO stageⅠB-ⅡA cervical squamous cell carcinoma diagnosed by surgery at the Fourth Affiliated Hospital of Hebei Medical University from July 2008 to December 2011 were conducted, selected from 439 cases. They were all in accordance with the following five criteria, First, all patients underwent radical operation of cervical carcinoma at the Fourth Affiliated Hospital of Hebei Medical University; Second, FIGO stageⅠB-ⅡA; Third, they were all proved by pathology after surgery; Fourth, clinical and follow-up data were relatively complete; Fifth, they had no other tumors; Sixth, all dead patients were caused by cervical cancer. Patients factors(age, menstruation, reproductive history), clinical data of tumor(FIGO stage, diameter and shape of tumor, tumor differentiation, depth of tumor invasion, lymph vascular space invasion, lymph node metastasis, Operative margin, internal orifice of the uterus), treatment and the relationship between lymph node metastasis and other factors were included in this study.SPSS21.0 was used for statistical analysis. The enumeration data usedχ2 test, single factor analysis of prognosis used Kaplan-Meier survival analysis and Log rank test. The multivariate analysis of significant factors use the COX regression model, and the significance judge standard was P<0.05.Results:1 AgeAmong the 307 patients, the current study showed the age was 25~71 years old, and the median age was 48 years old, while the average age was 55 years old. The number of patients whose age was not large than 35 years old was 26(8.5%), and large than 35 years old was 281(91.5%). And the number of patients between 41 and 45 years old was 66(21.5%), while the number of patients between 46 and 50 years old was 65(21.5%). The data showed that patients between 41 and 45 years old had the largest morbidity and the second was between 46 and 50 years old.2 Menopause and Reproductive HistoryThe number of Non-menopause females was 247( 80.5%), and menopause was 60(19.5%). The number of patients who gave birth to no more than 2 times was 220(71.7%), and more than 2 times was 87(28.3%).This result showed cervical squamous cell carcinoma often occurs to Non-menopause females and females reproductive history was no more than 2 times.3 Clinical manifestation and SignsThe number of patients whose manifestation was contact bleeding was 159(51.78%), abnormal vaginal bleeding 122(39.7%), abnormal vaginal discharge 53(17.3%), and it showed contact bleeding was more-seen symptoms.4 Survival rateThe survival time distributed from 2 months to 77 months, and the median time was 39 months. There were 25 patients died 5 years, while the three overall survival rate was 91.9% and the five year overall survival rate was 89.2%.Lymph vascular space invasion(LVSI), lymph node metastasis and internal orifice of the uterus influenced the prognosis ofⅠB-ⅡA cervical squamous cell carcinoma by single factor analysis(P<0.05). Age, menopause, reproductive history, FIGO stage, diameter and shape of tumor, tumor differentiation, depth of tumor invasion, Operative margin and treatment had no influence on the prognosis of Ⅰ B- Ⅱ A cervical squamous cell carcinoma(P>0.05).Use the COX regression model to analyze the effect of lymph vascular space invasion, lymph node metastasis and internal orifice of the uterus to survival, and the result showed lymph vascular space invasion and lymph node metastasis were statistically independent factors(P<0.05).5 Disease-free survival rateThere were 40 cases recurrence, the overall 2 year recurrence rate was 9.8%, the 3 year recurrence rate 13.0% and the 5 year recurrence rate was 10.8%.Single analysis: Lymph vascular space invasion, lymph node metastasis and internal orifice of the uterus influenced the DFS ofⅠB-ⅡA cervical squamous cell carcinoma(P<0.05). Age, menopause, reproductive history, FIGO stage, diameter and shape of tumor, tumor differentiation, depth of tumor invasion, Operative margin and treatment had no influence on the recurrence ofⅠB-ⅡA cervical squamous cell carcinoma(P>0.05).Use the COX regression model to analyze the effect of lymph vascular space invasion, lymph node metastasis and internal orifice of the uterus to DFS, and the result showed lymph vascular space invasion and lymph node metastasis were statistically independent factors(P<0.05). The relapse risk of patients with lymph vascular space invasion and lymph node metastasis was higher than patients without them.6 Risk factor of lymph node metastasisLVSI, internal orifice of the uterus, FIGO stage had statistically difference(P<0.05), while age, menopause, reproductive history, operative margin, tumor differentiation, depth of tumor invasion, and diameter of tumor had no influence on the lymph node metastasis ofⅠB-ⅡA cervical squamous cell carcinoma(P>0.05).Conclusion:1 The number of patients between 41 and 45 years old was 66(21.5%), which showed that patients between 41 and 45 years old had the largest morbidity.2 The number of Non-menopause females was 247(80.5%), and patients who gave birth to no more than 2 times was 220(71.7%). This result showed cervical squamous cell carcinoma often occurs to Non-menopause females and females reproductive history was no more than 2 times.3 The number of patients whose manifestation was contact bleeding was 159(51.78%), and it showed contact bleeding was more-seen symptoms.4 Lymph vascular space invasion, lymph node metastasis and internal orifice of the uterus influenced the survival and DFS ofⅠB-ⅡA cervical squamous cell carcinoma, but lymph vascular space invasion and lymph node metastasis were statistically independent factors. We should pay attention to these patients with such risk factors.5 LVSI, internal orifice of the uterus, FIGO stage were the risk factors of lymph node metastasis ofⅠB-ⅡA cervical squamous cell carcinoma.6 The early stage( Ⅰ B- Ⅱ A) young patients, who had none risk factors,could reserve ovaries.At the same time, they should be informed the risk of the ovary metastasis.7 Different ways of treatment of Ⅰ B- Ⅱ A cervical squamous cell carcinoma did not affect the prognosis. |
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