宫颈癌病理特征与预后的关系探讨

目的探讨病理特征与宫颈癌患者预后的关系。方法回顾性分析402例手术治疗的宫颈癌患者的病理资料，随防5年。结果（1）单因素分析显示：死亡组高临床分期、低肿瘤细胞分化、肿瘤体积大、伴有淋巴结转移和脉管癌细胞阳性的构成比高于生存组，且差异均有统计学意义（P均〈0．05）。（2）临床分期[相对危险度（relativerisk，RR）=2．077，95％CI：1．521-2．835]、细胞分化（RR=0．639，95％CI：0．487-0．839）和淋巴结转移（RR=3．616，95％CI：2．293-5．702）是影响预后的独立病理因素。（3）Ⅰa、Ⅰb、Ⅱa和Ⅱb期患者的5年生存率分别是94．7％、88．O％、71．7％和65．5％，差异有统计学意义（P=0．000）。癌细胞低分化、中分化、高分化者的5年生存率分别足71．0％、81．2％和86．5％，差异有统计学意义（P=0．004）。有、无淋巴结转移者5年生存率分别是63．2％和86：3％，差异有统计学意义（P=0．000）。结论临床分期、肿瘤分化程度，盆腔淋巴结转移情况是影响宫颈癌手术治疗预后的重要因素，重视宫颈癌的普查，做到早诊断早治疗，术中彻底清除阳性淋巴结可改善预后。

The relationship of the clinicopathological characteristics and prognosis for cervical carcinoma

Objective To investigate the relationship of the clinicopathological characteristics and prognosis for cervical carcinoma. Methods The pathological data of 402 patients with surgery for cervical carcinoma were reviewed, and followed up for 5 years. Results （ 1 ）Univariate analysis showed that the pro- portion of high clinical stages, poorly cellular differentiation, bigger tumor volume, with lymphatic metastasis and the positive of vascular tumor cell in death patients was higher than that in surviving patients, and the dif- ferences all had statistical significance （Pall〈 0.05）. （2） The clinical stages [ relative risk （RR） = 2.077,95%CI ： 1.521-2.835], cellular differentiation （RR= 0.639,95%CI：0.487-0,839） and lymphatic metastasis （RR= 3.616,95%CI：2.293-5.702） were the independently factor of prognosis. （3）The 5-year survival rate of pa- tients with stage Ⅰ a, Ⅰ b, Ⅱ a and Ⅱb were 94.7%,88.0%, 71.7% and 65.5%, and the difference had statisti- cal significance （P= 0.000）. The patients with poorly, moderately and well cellular differentiation were 71.0%, 81.2% and 86.5%, and the difference had statistical significance （P= 0.004）, The patients with lymphatic metastasis and without lymphatic metastasis were 63.2% and 86.3%, and the difference had statistical signifi- cance （P= 0.000）. Conclusion The clinical stages,cellular differentiation and positive lymph node are the important factors to influence the prognosis of cervical carcinoma. Attention to the cervical carcinoma screening, early detection and treatment, and clear positive lymph node can improve the prognosis.