Clinical Characteristics And Prognosis Analysis Of Patients With Lung Metastasis From Cervical Cancer

Objective:To investigate the clinical characteristics of cervical cancer patients with lung metastasis and the risk factors on prognosis.Methods:A total of 17011 adult patients with primary invasive cervical cancer in the surveillance,epidemiology and results(SEER)database from2010 to 2015 were collected.Patients were divided into lung metastasis group(n=738)and non-lung metastasis group(n=16273).The?~2 test and binary Logistic regression were used to compare the clinical characteristics between two groups.There were 459 lung metastasis patients with complete follow-up data for sub-analysis.The survival curve was drawn by Kaplan-Meier method and the 2-year overall survival rates(OS)was calculated.The influence of each factor on survival rate was analyzed by Log-rank method.Then the significant factors in univariate analysis were included in the multivariate Cox regression model to screen out the independent risk factors.Results:1.The incidence and the 2-year OS of cervical cancer patients with lung metastasis were 4.3%and 15.5%,respectively.2.Univariate analysis showed that factors associated with the incidence of lung metastasis include age at diagnosis(P<0.001),race(P=0.003),marital status(P<0.001),histological type(P<0.001),histological grade(P<0.001),tumor size(P<0.001),T stage(P<0.001),N stage(P<0.001).Binary logistic regression analysis showed that age>50(vs.age?50,OR=1.822;95%CI:1.527-2.173;P<0.001),small cell carcinoma of cervix(vs.Squamous cell carcinoma,OR=1.932;95%CI:1.128-3.307;P=0.016),histological grade G3-G4(vs.G1-G2,OR=2.021;95%CI:1.636-2.497;P<0.001),tumor size?4cm(vs.tumor size<4cm,OR=2.849;95%CI:2.015-4.027;P<0.001);T2(vs.T1,OR=1.609;95%CI:1.184-2.187;P=0.002),T3(vs.T1,OR=4.033;95%CI:3.024-5.380;P<0.001),T4(vs.T1,OR=5.120;95%CI;3.616-7.251;P<0.001),N1(vs.N0,OR=3.000;95%CI:2.492-3.613;P<0.001)were significantly associated with increased incidence of lung metastasis in cervical cancer patients,and were independent risk factors for lung metastasis in cervical cancer patients.3.The survival analysis showed that race(P=0.037),insurance status(P=0.007),histological grade(P=0.001),surgery at primary site(P=0.019),and tumor size(P=0.034)were significantly correlated with the patients'survival.Cox regression analysis showed that Asians(vs.whites,HR=0.582;95%CI:0.394-0.858;P=0.006),insured status(vs.non-insured status,HR=0.576;95%CI:0.408-0.813;P=0.002),hysterectomy(vs.non-hysterectomy,HR=0.576;95%CI:0.336-0.988;P=0.045),histological grade G3-G4(vs.G1-G2,HR=1.684;95%CI:1.263-2.244;P<0.001)were independent prognostic factors of cervical cancer with lung metastasis.Conclusions:1.The incidence of cervical cancer with lung metastasis is low with a poor survival rate.2.Incidence analysis showed that age>50 years old,histological type of small cell carcinoma,poor differentiation of tumor,tumor size?4cm,increased T stage and pelvic lymph node metastasis were independent risk factors for cervical cancer with lung metastasis.We should pay attention to these patients and strengthen follow-up and monitoring.3.The patients of Asian,with insured status,well differentiatied and hysterectomy for primary tumor may have a better long-term prognosis.Further data collection and in-depth study are needed to provide more clues for the conclusion.