探讨宫颈癌年轻(≤35岁)患者临床特征及影响预后的相关因素。

选择2010年3月至2012年3月，于深圳市龙华区人民医院妇科收治的157例宫颈癌患者为研究对象。按照其年龄，分别纳入≤35岁组(n＝82)及>35岁组(n＝75)。采用t检验或χ²检验，对2组宫颈癌患者一般临床资料及宫颈癌相关临床资料进行统计学比较。对≤35岁组患者随访5年，采用存活和死亡作为其预后判断指标，对可能影响宫颈癌年轻患者预后的16项因素，包括患者年龄、文化程度、居住地、人乳头瘤病毒(HPV)感染、初次性生活年龄、生育次数、肿瘤直径、肿瘤病理类型、肿瘤病理分级、宫颈间质浸润深度、淋巴结转移、肿瘤宫旁转移、脉管浸润、治疗方式、肿瘤复发及宫颈癌家族史，进行单因素分析。结合已有研究结果及临床经验，对单因素分析结果中具有统计学意义的因素，进行多因素非条件logistic回归分析，探讨影响宫颈癌年轻患者预后的独立危险因素。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。

①≤35岁组宫颈癌患者初次性生活年龄[(21.1±2.6)岁]小于>35岁组[(22.9±2.1)岁]；HPV感染率，接触性出血、腺癌、肿瘤宫旁转移及脉管浸润发生率(92.7%、78.0%、19.5%、56.1%、37.8%)均高于>35岁组(77.3%、45.3%、6.7%、36.0%、21.3%)，并且差异均有统计学意义(t＝4.745，χ²＝7.381、17.775、5.888、6.360、5.067;均为P<0.05)。②采用存活和死亡作为其预后判断指标，对可能影响宫颈癌年轻患者预后的因素进行单因素分析的结果显示，患者年龄、初次性生活年龄、生育次数、肿瘤直径、肿瘤病理类型、肿瘤病理分级、宫颈间质浸润深度、淋巴结转移、肿瘤宫旁转移、肿瘤脉管浸润、治疗方式、肿瘤复发及宫颈癌家族史共计13项因素，2组比较；差异均有统计学意义(t＝2.621、4.032、2.699、2.746，χ²＝11.721、15.571、8.313、4.877、9.015、13.577、4.911、3.855、9.526，均为P<0.05)。③对影响宫颈癌年轻患者预后的13项因素的多因素非条件logistic回归分析结果显示，肿瘤病理类型(OR＝6.214, 95%CI: 1.214～19.154, P<0.05)，肿瘤病理分级(OR＝10.547, 95%CI: 2.017～23.574, P<0.05)，宫颈间质浸润深度(OR＝3.019, 95%CI: 1.011～9.116, P<0.05),淋巴结转移(OR＝2.214, 95%CI: 1.215～8.067, P<0.05)，肿瘤宫旁转移(OR＝1.368, 95%CI: 1.084～7.008, P<0.05)，肿瘤脉管浸润(OR＝2.007, 95%CI: 1.006～11.068, P<0.05)，治疗方式(OR＝1.097, 95%CI: 1.068～9.106, P<0.05)及肿瘤复发(OR＝9.164, 95%CI: 2.167～35.168, P<0.05)，均为影响宫颈癌年轻患者预后的独立危险因素。

宫颈癌年轻患者的疾病恶性程度较高。影响宫颈癌年轻患者预后的危险因素较多，应早期对宫颈癌进行预防、筛查、诊断及治疗，以减少宫颈癌年轻患者并改善其预后。

To explore the clinical features of cervical cancer young patients (≤35 years old) and related factors affecting on prognosis.

From March 2010 to March 2012, a total of 157 cervical cancer patients hospitalized in People′s Hospital of Longhua District of Shenzhen were chosen as research subjects. According to their age, 82 cases were included into ≤ 35 years old group, and 75 cases were included into > 35 years old group. The t test or chi-square test was used to compare the differences of general and cervical cancer related clinical data between two groups of cervical cancer patients. Patients in ≤ 35 years old group were followed up for 5 years, and survival and death were used as prognostic judgment indicators for cervical cancer young patients. Univariate analysis was used to explore the risk factors which affected on prognosis of cervical cancer young patients in 16 factors, including patient age, education level, place of residence, human papillomavirus (HPV) infection, initial sexual life age, number of births, tumor diameter, tumor pathology, tumor pathological grade, depth of cervical interstitial invasion, lymph node metastasis, tumor parametrial metastasis, vascular invasion, treatments, tumor recurrence and family history of cervical cancer. With existing research results and clinical experience, multivariate unconditional logistic regression analysis were performed in statistically significant factors in the results of univariate analysis to explore the independent risk factors which affected on prognosis of cervical cancer young patients. This research was in line with the World Medical Association Declaration of Helsinki revised in 2013.

①The initial sexual life age of cervical cancer patients in ≤ 35 years old group [(21.1±2.6) years old] was younger than that in > 35 years old group [(22.9±2.1) years old]. The incidence of HPV infection, contact bleeding, adenocarcinoma, tumor parametrial metastasis and vascular invasion of cervical cancer patients in ≤ 35 years old group (92.7%, 78.0%, 19.5%, 56.1%, 37.8%) were all higher than those in > 35 years old group (77.3%, 45.3%, 6.7%, 36.0%, 21.3%), and the differences were statistically significant(t=4.745, χ²=7.381, 17.775, 5.888, 6.360, 5.067; all P<0.05). ②Univariate analysis of prognosis influencing factors of cervical cancer young patients with survival and death of prognostic judgment indicators showed that there were 13 factors has statistical significance in patient age, initial sexual life age, number of births, tumor diameter, tumor pathology, tumor pathological grade, depth of cervical interstitial invasion, lymph node metastasis, tumor parametrial metastasis, vascular invasion, treatments, tumor recurrence and family history of cervical cancer (t=2.621, 4.032, 2.699, 2.746; χ²=11.721, 15.571, 8.313, 4.877, 9.015, 13.577, 4.911, 3.855, 9.526; all P<0.05). ③Multivariate unconditional logistic regression analysis of prognosis influencing factors of cervical cancer young patients in 13 factors showed that the pathological type of tumor (OR=6.214, 95%CI: 1.214-19.154, P<0.05), tumor pathological grade (OR=10.547, 95%CI: 2.017-23.574, P<0.05 ), depth of cervical interstitial invasion (OR=3.019, 95%CI: 1.011-9.116, P<0.05), lymph node metastasis (OR=2.214, 95%CI: 1.215-8.067, P<0.05), tumor parametrial metastasis (OR=1.368, 95%CI: 1.084-7.008, P<0.05), tumor vascular invasion (OR=2.007, 95%CI: 1.006-11.068, P<0.05), treatments (OR=1.097, 95%CI: 1.068-9.106, P<0.05) and tumor recurrence (OR=9.164, 95%CI: 2.167-35.168, P<0.05) were all independent risk factors of the prognosis of cervical cancer young patients.

Cervical cancer young patients have a higher grade of malignancy. There are many risk factors affecting on the prognosis of cervical cancer young patients. Early prevention, screening, diagnosis and treatment of cervical cancer should be carried out to reduce the number of cervical cancer young patients and improve the prognosis.