- 期刊
子宮頸癌術後放射線治療病人組織病理學預後因子之多變數分析
Multivariate Analysis of the Histopathologic Prognostic factors for Cervical Cancer Patients Treated by Surgery and Post-Operative Radiation
摘要
目的：本文研究的目的是從子宮頸癌作過子宮切除手術及術後放療的病人中檢視其病理報告，從其中七項病理發現，利用統計方法分析那些是重要的預後因子。材料與方法：彰化基督教醫院南郭醫學中心放射腫瘤科，自民國七十四年十二月一日迄民國八十年十二月三十一日，共計有126例經病理診斷證實之第一與第二期子宮頸癌病人，接受過根治性子宮切除術合併骨盆腔淋巴腺摘除術（包括全子宮切除術在內）與術後輔助性放射線治療。接受放射線治療主要來自術後病理檢查發現有淋巴腺轉移，手術邊緣有癌細胞侵犯，淋巴血管浸潤，原發腫瘤大於或等於3.0公分，子宮旁組織侵犯，子宮體擴散或僅作單純子宮切除術等因素。體外放射線劑量通常全骨盆腔接受39.6至61.2 Gy之腫瘤劑量，另外在陰道縫合緣再追加腔內近接治療。所有接受過完整放射線治療的病患其追蹤期最短為8個月，最長的為256個月（中值追蹤期：113個月）。與預後相關之病理組織學參數如病理學分類、腫瘤分化程度、腫瘤縱深徑、淋巴血管間隙侵犯、子宮體擴散、子宮旁組織侵犯、陰道侵犯及骨盆淋巴腺轉移等，皆經搜集分類並以統計軟體作單變數與多變數分析。結果：所有的126例個案皆經過審慎的評估，分析與追蹤一直到研究結束（民國九十年六月底）。到目前已有半數病人（63例）死亡。存活期間的計算是由病理診斷日算起直到最後追蹤日期或死亡日期。依據外科分期的結果，IB，IIA，IIB各期之估計五年與十年存活率分別為65%，75%，62%與59%， 49%，53% （p＞0.05）。單變數分析結果指出，骨盆腔淋巴腺轉移、組織病理學分類、腫瘤大小與子宮體侵犯四個變項，對存活率有顯著性的影響（p＜0.05）。經過Cox regression model進行多變數分析以後，僅有組織病理學分類與骨盆腔淋巴腺轉移二變項，被鑑定為影響子宮頸癌病患治療後五年及十年存活率之獨立且顯著之預後因子（p＜0.005）。結論：本研究從子宮頸癌作過子宮切除術及術後放療的126例病人，經Cox氏模型的統計分析後，發現組織病理學分類為非鱗狀上皮細胞癌與骨盆腔淋巴結轉移個數在2以上，其五年及十年的存活率最差，且是兩個獨立而意義顯著之預後變數。
並列摘要
Purpose: The purpose of this investigation is to evaluate the histopathologic reports from cervical cancer patients who had undergone hysterectomy and post-operative irradiation, and, from seven major pathologic findings, to analyze what are important prognostic factors by statistical methods. Materials and Methods: Between 1st, Dec. 1985 and 31, Dec. 1991, 126 patients with pathology proven stages I and II carcinoma of the uterine cervix were treated by radical hysterectomy and pelvic lymphadenectomy (some of them underwent abdominal total hysterectomy) (ATH) followed with post operative irradiation at Department of Radiation Oncology, Chang-hua Christian Hospital. The indications for radiotherapy were based on pathologic findings including lymph node metastasis, positive Surgical margins, lymphovascular permeation, primary tumor size≧3.0 cm, parametrial involvement, corpus invasion, previous inadequate surgery (ATH) or more than one combination of the above. Patients usually received external beam irradiation 39.6 Gy to 61.2 Gy to the whole pelvis, and the vaginal cuff were boosted by intravaginal brachytherapy. All patients who received complete course of radiotherapy had follow-up period between 8 and 256 months (median: 113 months). The prognosis related histologic parameters including histologic subtypes, tumor grade, longitudinal tumor dimension, lymphovascular space invasion, corpus invasion, parametrial extension, vaginal invasion and pelvic lymph node(s) (PLN) metastases were collected and evaluated with univariate and multivariate analysis. Results: All the 126 cases were evaluated, analyzed and followed until closure of this study (Jun. 2001). Half(63) of all the cases died. The survival duration was calculated from time of histologic diagnosis to the time of last follow-up or death. The estimated 5- and 10-year survival rate of surgical stages IB, IIA and IIB were 65%, 75%, 62% and 59%, 49%, 53%respectively (p ＞ 0.05). Univariate analysis revealed that PLN metastases, histologic subtype, tumor size and corpus invasion were significant in survival (p ＜ 0.05). Among these variables, we found that histologic subtype and PLN metastases were identified as the most independent and significant prognostic factors (p ＜ 0.005) which have major analysis using Cox regression model. Conclusions: In the current study, which enrolled 126 cases of cervical cancer patients having hysterectomy and post-operative irradiation, we found that histologic subtype (non-See from pathologic classification) and PLN metastases (number of metastatic nodes more than 2) have the worst 5- and 10year survival rate, and were recognized as two independent and significant prognostic variables by Cox's model.