| Objective:from January 2009 to January 2014 in the first affiliated hospital of kunming medical university of surgical treatment of 116 cases of stage ??? A cervical cancer patients with clinical data were retrospectively analyzed,to explore the characteristics of cervical cancer pathogenesis,clinical manifestations,surgical treatment and postoperative adjuvant therapy and prognosis related factors,to understand the clinical characteristics of cervical cancer.Method:collected from January 2009 to January 2014 in the first affiliated hospital of kunming medical university during cervical cancer radical treatment of department of gynaecology,clinical stage for ??? A period of 116 patients with cervical cancer were starting to age,clinical symptoms,surgery,pathology and prognosis related clinical data,perform statistical analysis.SPSS 23.0 statistical software was used to process the data,percentage(%)was used to represent the counting data,and t test or Z test was selected for measurement data according to data distribution characteristics.P<0.05 was statistically significant.Results:1.Age distribution characteristics:the minimum age of 116 patients with cervical cancer was 26 years old,the maximum age was 69 years old,the average age of onset was(44±12.74)years old,the high incidence age was 36?50 years old,accounting for 59.5%of the total number of cases.2.Clinical performance:in 116 patients with cervical cancer starting to contact hemorrhages,62 cases of patients,symptoms(53.4%),31 patients with irregular vaginal bleeding,accounted for 26.7%,16 patients with no obvious clinical symptoms,accounted for 13.8%,a relatively rare patients for vaginal drainage,5 cases,accounted for 4.3%,followed by abdominal pain,abdominal distension and other symptoms in 2 cases,accounting for 1.7%.The first symptom of vaginal bleeding(including contact bleeding and irregular vaginal bleeding)was the most common,accounting for 93 cases(80.1%).3.The pathological data:in this study,116 cases of cervical cancer patients:97 patients with stage ?(83.6%),? A stage of 19 cases(16.4%).There were 100 cases(86.2%)of squamous cell carcinoma and 16 cases(13.8%)of adenocarcinoma.There were 74 cases(63.8%)of patients with superficial muscular layer infiltration(<1/3 cervical muscular layer)and 42 cases(36.2%)of patients with deep muscular layer infiltration(2/3 cervical muscular layer).Histologically,52 patients(44.8%)were highly differentiated,21(18.1%)were moderately differentiated,and 43(37.1%)were poorly differentiated.There were 16 patients(13.8%)with lymph node metastasis and 100 patients(86.2%)without lymph node metastasis.There were 22 patients(19%)with vascular/nerve infiltration and 94 patients(81.0%)without vascular/nerve infiltration.There were 3 patients(2.59%)with para-uterine tumor infiltration,and 103 patients(88.8%)without para-uterine tumor infiltration.No residual tumor was observed at the surgical margins.4.Cervical Papillomavirus(HPV)test:in this study,there were 54 cases of 116 cervical cancer patients who underwent HPV test before surgery,accounting for 46.6%(54/116)of the total number of cases,among which 52 cases were HPV positive(44.8%(52/54),and 21 cases were negative(3.7%(2/54).5.Different stage cervical cancer pathological characteristics:? period of 8 cases of cervical cancer patients with lymph node metastases,accounted for 8.2%(8/97),8 ?A stage in patients with lymph node metastasis,accounted for 42.1%(8/19),the difference was statistically significant(P<0.05),? A stage cervical lymph node metastasis risk is higher than ?.Infiltrating ? stage cervical cancer patients without palace,? A stage of A palace beside infiltration in 3 patients,15.8%(3/19),the difference was statistically significant(P<0.05),? A stage cervical cancer occur near the palace are riskier than stage ? tumor infiltration.I stage cervical cancer patients with deep muscularis infiltration(two-thirds of the cervical muscle layer or higher),30 cases accounted for 30.9%(30/97),? A stage deep muscularis infiltrate in 12 patients with A phase,63.2%(12/19),the difference was statistically significant(P<0.05),? A stage cervical cancer occur deep muscularis infiltration is more risky than phase ?.6.Treatment:in this study,116 patients with cervical cancer underwent "extensive total hysterectomy+pelvic lymph node resection",and 45 patients retained bilateral ovaries.Ninety patients(77.6%)were treated with open surgery,and 26 patients(22.4%)with laparoscopic surgery.Laparotomy group removed lymph node number is 8 pieces of the minimum value,maximum value for 37,the average removal(19.25±12.25),group of laparoscopic resection of lymph node number minimum value is 2 pieces,the maximum of 47,the average removal(16±7.25),two groups of removal of the number of lymph nodes(P<0.05)difference was statistically significant,more open surgical excision lymph node number than laparoscopic surgery group,There was no significant difference in intraoperative blood loss,surgical complications,3-year and 5-year overall survival rate and 5-year tumor-free survival rate between the open group and the laparoscopic group(P>0.05).16 cases of cervical adenocarcinoma intraoperative,3 patients with bilateral ovaries,accounted for 18.8%,no reservation 13 patients with bilateral ovaries,accounted for 81.3%,retaip bilateral ovarian adenocarcinoma of cervical cancer rates were 100%at 3 and 5 years survival rate and 5-year disease-free surial rate was 33.3%(1/3),yet to keep patients with ovarian and cervical adenocarcinoma 3 year survival rate was 92.3%(12/13),the 5-year survival rate and 5-year disease-free surial rate was 69.2%(9/13).7.Postoperative adjuvant treatment:postoperative adjuvant treatment was given to patients with lymph node metastasis,paratalic infiltration,low differentiation,vascular/nerve invasion and other risk factors.Among the 116 patients,64(55.2%)had either risk factor.Specific risk factors in 64 cases of patients,21 patients did not return to our hospital surgery adjuvant therapy,43 cases in our hospital to accept the postoperative adjuvant therapy,67.2%(43/64),in our hospital in patients with postoperative adjuvant therapy,there are 24 year routine radiation and chemotherapy(chemotherapy for platinum weekly plan),55.8%(24/43),19 routine chemotherapy alone(TP),44.2%(19/43).The 3-year survival rate of postoperative patients in the concurrent chemoradiotherapy group was significantly higher than that in the chemotherapy group(P<0.05).There was no significant difference in 5-year survival rate and 5-year tumor-free survival rate between the two postoperative adjuvant treatments(P>0.05).8.Prognostic factors analysis,single factor analysis:116 cases of cervical cancer patients with lymph node metastasis in patients with 5-year disease-free survival rate was 85.0%(85/100),associated with lymph node metastasis patients was 43.8%(7/16),the difference was statistically significant(P<0.05),for no lymph node metastasis of cervical cancer patients 5-year disease-free surial rate was significantly higher than that of patients with lymph node metastasis.The 5-year tumor-free survival rate was 86.3%(63/73)in patients with histologically graded high school differentiation(G1/G2),and 67.4%(29/63)in patients with low differentiation(P<0.05).The 5-year tumor-free survival rate in the high school differentiation group was higher than that in the low differentiation group.The 5-year tumor-free survival rate was 86.5%(64/74)in patients with superficial muscular infiltration(the infiltration depth<1/3 of cervical muscular layer)and 66.7%(28/42)in patients with deep muscular infiltration,and the difference was statistically significant(P<0.05).The 5-year tumor-free survival rate of cervical cancer patients with shallow muscular infiltration was higher than that of patients with deep muscular infiltration.The 5-year tumoral survival rate of patients without vascular/nerve invasion was 84%(79/94),and that of patients with vascular/nerve invasion was 59.1%(13/22),with statistically significant difference(P<0.05).The 5-year tumoral survival rate of patients without vascular/nerve invasion was higher than that of patients with vascular/nerve invasion.Patients with stage ? cervical cancer 5-year disease-free survival rate was 85.6%(83/97),? A stage patients was 47.4%(9/19),the difference was statistically significant(P<0.05),? 5-year disease-free surial rate was significantly higher than patients with ? A stage patients with A period.There was no significant difference in the effect of pathological type on the prognosis of cervical cancer patients(P>0.05).Results of multivariate analysis:clinical stage of tumor FI GO,cervical muscle infiltration depth,lymph node metastasis,vascular/nerve invasion were all independent factors affecting the prognosis of cervical cancer(P<0.05).Conclusion:1.The peak age of 116 patients with early cervical cancer treated by surgery in our hospital was 36?50 years old.2.The common clinical manifestations of cervical cancer are contact bleeding,followed by irregular vaginal bleeding.Many patients have no obvious clinical symptoms and are diagnosed by cervical cancer screening and pathological examination.3.? A stage in patients with cervical lymph node metastasis,deep muscle layer infiltration,beside the palace and risk were higher than in patients with stage ?4.The number of pelvic lymph nodes in the open surgery group was more than that in the laparoscopic surgery group.5.The 3-year survival rate of postoperative chemoradiotherapy patients was higher than that of chemotherapy patients.6.Tumor staging,lymph node metastasis and vascular/nerve invasion are independent risk factors affecting the prognosis of cervical cancer. |
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