| Purpose:To investigate the survival of patients with cervical cancer and analyze the prognostic factors by retrospectively analyze the clinical data of ?B-?B cervical cancer patients treated in Qilu Hospital of Shandong University.To assess the efficacy of chemotherapy after radical surgery for ?B-?B cervical cancer.Methods:Part 1:Patients with cervical cancer(542 cases)treated in Shandong Province Qilu Hospital from April 2011 to December 2016 were reviewed and followed up.SPSS22.0.0 software was applied,and Kaplan-Meier analysis was performed to compare overall survival(OS)within groups,and Cox regression analysis was performed to identify factors associated with survival(p<0.05).Part 2:A systematic review of chemotherapy after radical surgery for ?B-?B cervical cancer was performed by searching databases,including MEDLINE and WEB of SCIENCE.Language was restricted to English.Data including overall survival,disease-free survival,recurrence and complication were extracted from both the chemotherapy and control groups.The results of similar trials were combined,and relative risk was used to express the results for the categorical variables.Results:Part 1:1.There were 542 ?B-?B cervical cancer patients involved in total,among 43 patients died of cervical cancer(7.9%).18(3.3%)were stage IB,267(49.3%)were stage ?B1,114(21.0%)were stage ?B2,117(21.6%)were stage IIA,26(4.8%)were stage ?B.The mean survival was 68.63 months,the 1,3,and 5-year overall survival were 98.3%,88.1%and 79.7%respectively.2.Prognostic factors including clinical staging,histopathological types,parametrial invasion,stromal invasion,lymph node metastasis and tumor size were analyzed.Univariate analysis showed that survival was related to FIGO staging(p=0.010),lymph node metastasis(p<0.001),parametrial invasion(p<0.001)and deep stromal invasion(p<0.001).Meanwhile the age,histological pathology,tumor diameters showed no statistical difference(p>0.05).3.Multivariable analysis showed that lymph node metastasis(p<0.001,OR=5.600,95%CI=[2.840?11.040])and parametrial invasion(p=0.006,OR=2.371,95%CI=[1.28?4.386])were independent prognostic factors related to survival.Part 2:Eight trials involving 861 patients were included in the study,2 were RCTs(Randomized-Controlled Trial),6 were retrospective studys.Compared with the control group,the chemotherapy group ?had an improvement in the 3-year overall survival(OS)(RR=1.31,95%CI:1.14?1.49,P<0.0001),?had an improvement in the 3-year disease-free survival(DFS)(RR?1.35,95%CI:1.01?1.81,P=0.04)),?did not have an increase in the rate of recurrence(RR = 0.79,95%CI:0.58?1.08,P =0.14);in the subgroup analysis,there was no statistical significance between chemotherapy and radiotherapy alone groups(RR = 0.92,95%CI:0.35?2.40,P = 0.86),as well as chemotherapy and radiotherapy&chemotherapy groups(RR =0.82,95%CI:0.56?1.22,P = 0.33)?had a decrease in the rate of complication,lymphedema(RR = 0.40,95%CI:0.24?0.66,P=0.0004),urinary stricture(RR=0.32,95%CI:0.16?0.63,P = 0.001)and ileus(RR = 0.25,95%CI:0.11?0.57,P=0.0009).Conclusion:1.FIGO staging,lymph node metastasis,parametrial invasion and deep stromal invasion may be prognostic factors of patients with cervical cancer.Among them,LNM and DSI may be considered as independent prognostic factors.2.Chemotherapy after radical surgery can improve the 3-year OS and 3-year DFS,and eliminate the rate of complication. |
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