Objective: To evaluate the survival, complications and prognostic factors in patients with stageⅠb2 and Ⅱa2 cervical squamous cell carcinoma treated by primarily radical surgery with or without postoperative adjuvant therapy. Methods: The clinical and pathological data of patients with stageⅠb2 and Ⅱa2 cervical squamous cell carcinoma treated in the Cancer Hospital of the University of Chinese Academy of Sciences from January 2015 to January 2018 were retrospectively analyzed. All patients underwent Querleu-Morrow classification (Q-M classification) C2 radical surgery, including extensive hysterectomy+pelvic lymphadenectomy with or without adjuvant therapy based on postoperative risk factors. Survival rate was calculated by Kaplan-Meier method and survival curve was drawn. Univariate analysis was performed by using the log-rank test to analyze the clinicopathological factors related to the prognosis of patients. Multivariate analysis was performed by using Cox regression method to analyze independent risk factors affecting survival prognosis. Results: (1) The median age of 643 patients with cervical squamous cell carcinoma was 50 years old (45-58 years old). Clinical stage: 260 cases (40.4%, 260/643) of stage Ⅰb2, 383 cases (59.6%, 383/643) of stage Ⅱa2. (2) Among 643 cases underwent Q-M classification C2 surgery, 574 cases (89.3%, 574/643) of them received adjuvant therapy and 184 cases (28.6%, 184/643) of them had grade 3-4 complications after treatment, including 134 cases (20.8%, 134/643) early complications and 66 cases (10.3%, 66/643) late complications. The incidence of grade 3-4 complications in 574 patients received postoperative adjuvant therapy was 30.1% (173/574), which was significantly different from that in 69 patients who received surgery alone (15.9%, 11/69; χ²=6.08, P=0.014). (3) All 643 cases were followed up, and the median follow-up time was 40 months (3-76 months). During the follow-up period, 117 cases (18.2%, 117/643) recurred, including 45 cases (7.0%, 45/643) of local recurrence, 54 cases (8.4%, 54/643) of distant metastasis, and 18 cases (2.8%, 18/643) of local recurrence and distant metastasis. The 5-year progression-free survival (PFS) and 5-year overall survival (OS) rates of patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma were 79.9% and 85.5%, respectively. Univariate analysis showed that pelvic lymph node metastasis, para-aortic lymph node metastasis, deep stromal infiltration, and lymph-vascular space invasion were significantly associated with 5-year PFS in patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma (all P<0.05). The maximum diameter of tumor, pelvic lymph node metastasis and para-aortic lymph node metastasis were significantly associated with the 5-year OS of cervical squamous cell carcinoma in stages Ⅰb2 and Ⅱa2 (all P<0.05). Multivariate analysis showed that pelvic lymph node metastasis and para-aortic lymph node metastasis were independent factors affecting 5-year PFS and 5-year OS in patients with stage Ⅰb2 and Ⅱa2 cervical squamous cell carcinoma (all P<0.01). Conclusion: Radical surgery is a feasible and effective primary treatment for stagesⅠb2 and Ⅱa2 cervical squamous cell carcinoma, with a high 5-year survival rate and an acceptable complication rate.
目的： 探讨Ⅰb2和Ⅱa2期［根据国际妇产科联盟（FIGO）2009年标准］子宫颈鳞癌患者行根治性手术±辅助治疗的疗效及预后影响因素。 方法： 回顾性分析2015年1月至2018年1月中国科学院大学附属肿瘤医院收治的643例Ⅰb2和Ⅱa2期子宫颈鳞癌患者的临床病理资料，所有患者均行根治性手术，术式为Querleu-Morrow新分型（Q-M分型）C2型手术，手术范围包括子宫广泛性切除+盆腔淋巴清扫术，根据术后有无中、高危因素决定是否给予辅助治疗。采用Kaplan-Meier法计算生存率并绘制生存曲线；影响患者预后的相关临床病理因素分析，单因素分析采用log-rank检验，多因素分析采用Cox比例风险回归模型。 结果： （1）643例子宫颈鳞癌患者的中位年龄为50岁（45~58岁）；临床分期：Ⅰb2期260例（40.4%，260/643）、Ⅱa2期383例（59.6%，383/643）。（2）643例行Q-M分型C2型手术的子宫颈鳞癌患者中，574例（89.3%，574/643）因存在术后中、高危因素给予辅助治疗。643例患者中，184例（28.6%，184/643）患者治疗后出现3~4级并发症（同一患者早期、晚期并发症均出现时，计数时分别计入相应并发症中），其中早期并发症134例（20.8%，134/643）、晚期并发症66例（10.3%，66/643）。574例手术+辅助治疗患者的3~4级并发症发生率为30.1%（173/574），69例单纯手术患者为15.9%（11/69），两者比较，差异有统计学意义（χ²=6.08，P=0.014）。（3）643例子宫颈鳞癌患者均随访，中位随访时间为40个月（3~76个月）。随访期内复发117例（18.2%，117/643），包括局部复发45例（7.0%，45/643）、远处转移54例（8.4%，54/643）、局部复发+远处转移18例（2.8%，18/643）。Ⅰb2和Ⅱa2期子宫颈鳞癌患者的5年无进展生存率（PFS）和5年总生存率（OS）分别为79.9%和85.5%。单因素分析显示，盆腔淋巴结转移、腹主动脉旁淋巴结转移、间质浸润深度、淋巴脉管间隙浸润（LVSI）均与Ⅰb2和Ⅱa2期子宫颈鳞癌患者的5年PFS显著相关（P均<0.05）；肿瘤最大径、盆腔淋巴结转移、腹主动脉旁淋巴转移均与Ⅰb2和Ⅱa2期子宫颈鳞癌患的5年OS显著相关（P均<0.05）。多因素分析显示，盆腔淋巴结转移、腹主动脉旁淋巴结转移均为影响Ⅰb2和Ⅱa2期子宫颈鳞癌患者5年PFS及5年OS的独立因素（P均<0.01）。 结论： 根治性手术±辅助治疗是Ⅰb2和Ⅱa2期子宫颈鳞癌可行且有效的初始治疗方案，具有满意的5年PFS和5年OS以及可接受的并发症发生率。.