| Background and ObjectiveCervical cancer is the highest incidence of malignant tumor in the female reproductive system in the world,and ranks the fourth among the tumors that die from cancer in the world.With the arrival of the aging population in China,the number of elderly patients with cervical cancer has increased to a certain extent.therefore,to grasp the clinicopathological characteristics of elderly patients with cervical cancer and clarify the current situation of treatment mode of elderly patients with cervical cancer,it provides important reference value to improve the efficiency of clinical diagnosis and treatment.Materials and methodsThe clinical data of 46313 inpatients with cervical malignant tumor were collected from China Cervical Cancer Clinical diagnosis and treatment Database(1538 Database for short).Early cervical cancer includes IA1,IA2,IB1,IIA1,locally advanced cervical cancer including IB2 and IIA2,and advanced cervical cancer includes ?B??B.The patients with more than one high risk factor(positive lymph node,positive vaginal margin,positive paracenteal)were taken as the high risk group,the patients with more than one medium risk factor(adenocarcinoma,tumor diameter>4cm,positive lymphatic vessel,cervical interstitial infiltration?1pm 2)were taken as the middle risk group,and the patients without high risk factors and middle risk factors were taken as the non risk group.The postoperative adjuvant therapy in the high risk group took simultaneous radiotherapy and chemotherapy as the standard group,the radiotherapy ±chemotherapy group with more than 2 medium risk as the standard group,and the medium risk group with one medium risk factor and the group without risk factors as the standard group.The clinical,pathological and treatment characteristics of patients with cervical cancer in middle-aged and elderly groups were compared.There was significant difference between the two groups(P<0.05).The difference between the two groups was considered to be statistically significant(P<0.05).Result1 The constituent ratio of the two groups in different years and its changing trendIn the past 13 years,the constituent ratio of the elderly group increased with time,while that of the middle-aged group decreased with time.2 Clinical features2.1 FIGO stagingThe proportion of early cervical cancer in the elderly group was higher than that in the middle-aged group,and the proportion of locally advanced cervical cancer in the elderly group was lower than that in the middle-aged group(P<0.05).There was no significant difference in the proportion of advanced cervical cancer between the two groups(P>0.05).The proportion of stage IB1 and IB2 in the elderly group was lower than that in the middle-aged group,while the proportion of stage ?A1 and ?A2 in the elderly group was higher than that in the middle-aged group.2.2 General typesIn the early stage of cervical cancer,the proportion of exogenous type was lower than that of middle-aged group,and the proportion of endogenous type was higher than that of middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference between ulcerative type and cervical canal type(P>0.05).In locally advanced cervical cancer,the proportion of exogenous type was lower than that of middle-aged group,and the proportion of endogenous type was higher than that of middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference between ulcerative type and cervical canal type(P>0.05).There was no significant difference among different gross types of advanced cervical cancer(P>0.05).3 Histopathology3.1 Histological gradingEarly cervical cancer:the proportion of high differentiation in the elderly group was lower than that in the middle-aged group,and the proportion of middle-aged group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of low differentiation between the two groups(P>0.05).Locally advanced cervical cancer:there was no significant difference among different histological grades(P>0.05).Advanced cervical cancer:there was no significant difference among different histological grades(P>0.05).3.2 Histological typesEarly cervical cancer:the comparison of different histological types showed that the proportion of squamous cell carcinoma in the elderly group was higher than that in the middle-aged group,and the proportion of adenocarcinoma in the elderly group was lower than that in the middle-aged group,and the difference was statistically significant(P<0.05).Locally advanced cervical cancer:there was no significant difference among different histological types(P>0.05).Advanced cervical cancer:there was no significant difference among different histological types(P>0.05).4 Risk factors4.1 Different risk factor groupsThe proportion of early cervical cancer in the elderly group was higher than that in the middle-aged group,and the proportion in the non-risk group was lower than that in the middle-aged group(P<0.05),but there was no significant difference in the high-risk group(P>0.05).Locally advanced cervical cancer:there was no significant difference among different risk factors groups(P>0.05).The proportion of advanced cervical cancer in the elderly group without risk factors was significantly higher than that in the middle-aged group(P<0.05),but there was no significant difference between the high-risk group and the middle-risk group(P>0.05).4.2 High risk Group4.2.1 Number of high risk factorsEarly cervical cancer:there was no significant difference in the number of high risk factors between the two groups(P>0.05).Locally advanced cervical cancer:there was no significant difference in the number of high risk factors between the two groups(P>0.05).Advanced cervical cancer:there was no significant difference in the number of high risk factors between the two groups(P>0.05).4.2.2 Composition of high risk factors in different numbersEarly cervical cancer:the positive rate of single lymph node in the elderly group was lower than that in the middle-aged group,and the positive rate of single vaginal margin and vaginal margin in the elderly group was significantly higher than that in the middle-aged group(P<0.05).There was no significant difference in the proportion of other high risk factors between the two groups(P>0.05).Locally advanced cervical cancer:there was no significant difference in the number of high risk factors between the two groups(P>0.05).Advanced cervical cancer:there was no significant difference in the number of high risk factors between the two groups(P>0.05).4.2.3 Types of high risk factors4.2.3.1 Lymph node metastasisEarly cervical cancer:the positive rate of lymph nodes in the elderly group was lower than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the positive rate of lymph nodes between the two groups(P>0.05).There was no significant difference in the positive rate of lymph nodes between the two groups(P>0.05).4.2.3.2 Vaginal margin involvementEarly cervical cancer:the positive rate of vaginal incisal margin in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).Locally advanced cervical cancer:there was no significant difference in the positive rate of vaginal incisal margin between the two groups(P>0.05).There was no significant difference in the positive rate of vaginal incisal margin between the two groups(P>0.05).4.2.3.3 Para-uterine involvementThere was no significant difference in the positive rate of early cervical cancer between the two groups(P>0.05).Locally advanced cervical cancer:there was no significant difference in the proportion of paracenteal positive cervical cancer between the two groups(P>0.05).Advanced cervical cancer:there was no significant difference in the proportion of para-uterine positive between the two groups(P>0.05).4.3 Mid-risk Group4.3.1 Number of medium risk factorsEarly cervical cancer:there was no significant difference among different number of middle risk factors(P>0.05).Locally advanced cervical cancer:the proportion of 1 middle risk in the elderly group was lower than that in the middle-aged group,and the proportion of 2 middle-risk in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of 3 middle-risk and 4 middle-risk between the two groups(P>0.05).Advanced cervical cancer:there was no significant difference among different number of middle risk factors(P>0.05).4.3.2 Composition of medium risk factors in different numbersEarly cervical cancer:the proportion of single AC,single LVSI(+),AC+LVSI(+)and AC+ DSI>1/2 in the elderly group was lower than that in the middle-aged group,while the proportion of DSI>1/2,LVSI(+)+DSI>1/2 in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the number of risk factors among the other groups.Locally advanced cervical cancer:the proportion of single TD>4cm in the elderly group was lower than that in the middle-aged group,and the proportion of TD>4cm+DSI>1/2,in the middle-aged group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the number of medium-risk factors among the other groups(P>0.05).Advanced cervical cancer:there was no significant difference in the number of middle risk factors between the two groups(P>0.05).4.3.3 Types of medium risk factors4.3.3.1 Pathological typesEarly cervical cancer:the proportion of AC in the elderly group was lower than that in the middle-aged group,and the difference was statistically significant(P<0.05).Locally advanced cervical cancer:there was no significant difference in the incidence of AC between the two groups(P>0.05).Advanced cervical cancer:there was no significant difference in the incidence of AC between the two groups(P>0.05).4.3.3.2 Tumor diameterThere was no significant difference in the proportion of TD>4cm in advanced cervical cancer.4.3.3.3 Lymphatic vesselsEarly cervical cancer:the proportion of LVSI(+)in the elderly group was lower than that in the middle-aged group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of locally advanced cervical cancer(LVSI(+)between the two groups.Advanced cervical cancer:the proportion of LVSI(+)in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).4.3.3.4 Cervical stromaIn the early stage of cervical cancer,the proportion of DSI>1/2 in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).The proportion of DSI>1/2 in the elderly group was higher than that in the middle-aged group,and the difference was statistically significant(P<0.05).Advanced cervical cancer:there was no significant difference in the proportion of DSI?1/2or DSI>1/2 between the two groups(P>0.05).5 Analysis of treatment mode5.1 Surgical treatment5.1.1 Surgical approachIn the elderly group,the proportion of laparotomy in ?A1 stage was lower than that in laparoscopy,while the proportion of laparotomy in ?A2,?B1,?A1,?A2 and ?B stages was significantly higher than that in laparoscopy.There was no significant difference in the proportion of different surgical approaches between ?B2 and ?A??B.5.1.2 Types of hysterectomyIn the elderly group,the proportion of hysterectomy in ?B1 stage,?A1 stage and IIA2 stage B was higher than that in type C,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of different types of hysterectomy in other stages(P>0.05).5.2 Postoperative adjuvant therapyThe constituent ratio of the standard group in the high risk group showed an upward trend,while that of the non-standard group showed a downward trend(P=0.01).The constituent ratio of the standard group and the non-standard group with more than two medium-risk factors did not show an upward or downward trend with time(0.180,0.180,0.671),and the constituent ratio of the standard group and the non-standard group showed an upward trend,while that of the non-standard group showed a downward trend with time.The constituent ratio of the standard group with one medium-risk factor decreased with time,while that of the non-standard group increased with time,and the proportion of the standard treatment group(without adjuvant treatment group)decreased with time,while that of the non-standard treatment group(with adjuvant treatment group)increased with time.Conclusion(1)the constituent ratio of the elderly group increased with time,while that of the middle-aged group decreased with time,and the FIGO stage of the elderly group was relatively later than that of the middle-aged group.(2)the general type in the elderly group was mainly exophytic type.The proportion of exophytic type in ?A1-?A2 stage cervical cancer was lower than that in the middle-aged group,and the proportion of endogenous type in the elderly group was higher than that in the middle-aged group.(3)the histological grade of the elderly group was mainly medium differentiation and low differentiation,and the histological type was mainly squamous cell carcinoma.The proportion of high differentiation in the elderly group of early cervical cancer(stage ?A1,stage IA2,stage ?B1 and stage ?A1)was lower than that in the middle-aged group,the proportion of middle differentiation was higher than that in the middle-aged group,the proportion of squamous cell carcinoma was higher than that in the middle-aged group,and the proportion of adenocarcinoma was lower than that in the middle-aged group.(4)in the early stage(?A1,?A2,?B1,?A1),the positive rate of lymph nodes in the elderly group was lower than that in the middle-aged group,and the positive rate of vaginal margin in the high-risk group was higher than that in the middle-aged group.(5)the proportion of DSI>1/2 in the elderly group was higher than that in the middle-aged group in the middle-risk group of ?A1-?A2 stage cervical cancer.(6)transabdominal approach is the main surgical approach in the elderly group,and the surgical scope of most patients is insufficient.(7)the postoperative adjuvant therapy in the middle-high risk group tended to be standardized in the elderly group,there was no improvement in the postoperative adjuvant therapy in the middle-risk group with more than 2 medium-risk factors,and the middle-risk group with 1 medium-risk factor and the group without risk factors tended to be overtreated. |
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