目的 探讨Ⅰ-Ⅱa期宫颈癌患者术后近期复发相关因素.方法 选取手术治疗的Ⅰ-Ⅱa期(FIGO分期)宫颈癌患者430例.其中180例有完整病史资料和随访资料的患者的预后因素进行了回顾性分析.结果 单因素生存分析结果显示:临床分期、肿瘤≥4 cm、>2/3宫颈纤维肌壁浸润、淋巴结阳性和脉管癌栓患者预后较差,差异有统计学意义(P<0.05).化疗组、放疗组和同期化放疗+化疗2年复发率分别为23.1%、26.4%和78.2%,显著高于无辅助治疗组,差异有统计学意义(P<0.05);同期化放疗组2年复发率13.1%,与无辅助治疗组差异无统计学意义(P>0.05);辅助治疗四组中,同期化放疗组2年复发率最低,但是远处转移率高于局部复发率.结论 >2/3宫颈纤维肌壁浸润、腹主动脉旁或者髂总淋巴结转移是Ⅰ-Ⅱa期宫颈癌术后近期复发的最重要因素.术后辅以同期化放疗可有效降低局部复发率,但减少远处转移需进一步改进.%Objective Tostudy the related factors of recurrence in the near future after radical surgery in stage Ⅰ-Ⅱa cervical cancer patients.Methods 430 patients with clinical stage Ⅰ - Ⅱ a cervical carcinoma were treated with radical hysterectomy and pelvic lymphadenectomy.Among them, 180 patients who had enough informations were assessed retrospectively.Results Clinical stage,tumor size (≥4cm) ,deep stromal invasion( ＞ 2/3 ), lymph node metastasis and lymphatic permeation were the poor prognostic factors in univariate survival analysis (P ＜ 0.05 ).The 2-year local recurence,distant metastasis and death accounted for 0.0％ ,75.0％ and 33.3％ ,respectively,among 12 para-aortic or common iliac lymph node-positive cases; the 2-year local recurence, distant metastasis and death accounted for 7.4％ ,22.2％ and 0.0％ among 27 pelvic lymph node-positive case.These patients were divided into five groups as no adjuvant therapy group (74 cases) ,chemotherapy group ( 13 cases) ,radiotherapy group (30 cases),chemoradiotherapy group (38 cases) and chemoradiotherapy plus chemotherapy group (23 cases).The 2-year recurrent rate of chemotherapy group, radiotherapy group and chemoradiotherapy plus chemotherapy group (23.1％,26.4％ and 78.2％ ,respectively) were significantly higher than that of the no adjuvant therapy group ( 1.4％ ,P ＜0.05).However,the recurrent rate of chemoradiotherapy group (13.1％) was higher than that of the no adjuvant therapy group ( P ＞ 0.05 ).Among the four groups, the recurrent rate of the chemoradiotherapy group was much lower than those of the other three groups.However,the distant metastases rate was significantly higher than that of local recurrence.Conclusion Para-aortic or common iliac lymph node metastasis, deep stromal invasion ( ＞ 2/3 ) in the Ⅰ-Ⅱa cervical cancer patients were the most important factors of postoperative recurrence.Chemoradiotherapy can effectively reduce the local recurrence rate after surgery.
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