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目的探讨术前血浆D-二聚体水平(D-D)对早期宫颈癌术后复发的影响。方法采用前瞻性随访研究方法,以2009年1月-2012年12月期间早期宫颈癌患者为研究对象,根据术前血浆D-二聚体水平分为D-D升高组和D-D正常组,随访以电话随访为主,随访终点事件为宫颈癌复发。生存率估算应用Kaplan-Meier法,组间生存率曲线差异采用log-rank检验,应用多变量Cox比例风险回归分析宫颈癌复发的独立危险因素。结果 D-D正常组有11例复发,复发时间为15~62个月,中位时间36.0个月,5年无复发生存率为88.8%;D-D升高组有16例复发,复发时间6~50个月,中位时间为25.5个月,5年无复发生存率为74.0%。Kaplan-Meier曲线表明,D-D升高组无复发生存率显著低于D-D正常组(χ2=4.805,P=0.028)。多变量Cox比例风险回归分析发现,淋巴结转移、FIGO分期、D-D水平、治疗方法为影响宫颈癌复发的独立危险因素。结论术前D-二聚体水平是影响宫颈癌复发的危险因素,有助于更好地指导治疗和判断预后。
Objective To investigate the effect of preoperative plasma D-dimer (D-D) on the recurrence of early cervical cancer. Methods A prospective follow-up study was conducted in early stage cervical cancer patients from January 2009 to December 2012. The patients were divided into DD-positive group and DD-normal group according to the preoperative plasma D-dimer level. Follow-up Telephone follow-up, follow-up end-point event for cervical cancer recurrence. The Kaplan-Meier method was used to estimate the survival rate. Log-rank test was used to evaluate the difference of survival rate between groups. Multivariate Cox proportional hazards regression was used to analyze the independent risk factors of cervical cancer recurrence. Results In the normal DD group, 11 cases relapsed, the recurrence time was 15-62 months, the median time was 36.0 months, and the 5-year recurrence-free survival rate was 88.8%. In the DD elevated group, 16 cases relapsed and the recurrence time was 6-50 Month, the median time was 25.5 months, 5-year recurrence-free survival rate was 74.0%. Kaplan-Meier curve showed that the recurrence-free survival of D-D elevated group was significantly lower than that of D-D normal group (χ2 = 4.805, P = 0.028). Multivariate Cox proportional hazards regression analysis found that lymph node metastasis, FIGO stage, D-D levels, treatment is an independent risk factor for cervical cancer recurrence. Conclusion Preoperative D-dimer level is a risk factor for cervical cancer recurrence, which will help to better guide the treatment and prognosis.