Impact of impaired glucose regulation on recurrence within 2 years after modified radical surgery in patients with cervical cancer

doi:10.3877/cma.j.issn.1673-5250.2024.02.015

Objective

To explore the impact of impaired glucose regulation (IGR) on recurrence within 2 years after modified radical surgery in cervical cancer patients.

Methods

A total of 106 patients with newly diagnosed cervical cancer who were hospitalized in the Second Hospital of Shijiazhuang from March 2019 to February 2021 were selected as the study subjects. All patients were scheduled for modified radical surgery of cervical cancer. By retrospective analysis, the patients were divided into recurrence group (n=20) and non-recurrence group (n=86) according to the tumor recurrence within 2 years after operation. According to the definition of the Guidelines for Prevention and Treatment of Type 2 Diabetes in China (2017 Edition), patients were evaluated and divided into IGR and normal glucose tolerance (NGT). And IGR included impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Log-rank test was used to compare the risk of recurrence within 2 years after modified radical surgery of cervical cancer between two groups. Cox proportional hazard regression was used to analyze the independent influencing factors of recurrence within 2 years after modified radical hysterectomy in patients with cervical cancer, and a nomogram prediction model for recurrence within 2 years after modified radical surgery of cervical cancer patients was constructed based on these independent influencing factors. This study was approved by the Medical Ethics Committee of the Second Hospital of Shijiazhuang (Approval No. KY2019-012). All patients signed the informed consent forms for clinical research.

Results

① Among the 106 patients in this study, 33 cases were diagnosed as IFG and 25 cases as IGT. The proportion of patients with IGR was 54.7%. The recurrence time of 20 patients with cervical cancer recurrence was 15.50 months. The risk of recurrence within 2 years after modified radical resection in patients with IGR was higher than that in patients with NGT, and the difference was statistically significant (χ²=8.93, P=0.003). ② The proportion of patients with International Federation of Gynecology and Obstetrics (FIGO) stage ⅡA, the rate of lymphatic vascular invasion (LVSI), the incidence of tumor invasion of the cervical stroma of 1/3 deep, the positive rate of parauterine tissue infiltration, the proportion of patients with IGR, and the serum levels of squamous cell carcinoma antigen (SCC) and cytokeratin 19 fragment (CYFRA21-1) in recurrence group were higher than those in non-recurrence group, and the differences were statistically significant (P<0.05). ③ Cox proportional hazard regression analysis showed that patients with IGR (HR=4.342, 95%CI: 1.192-15.820, P=0.026), FIGO stage ⅡA (HR=3.794, 95%CI: 1.316-10.935, P=0.014), LVSI (HR=3.017, 95%CI: 1.137-8.007, P=0.027), serum SCC level increased (HR=1.250, 95%CI: 1.015-1.538, P=0.036), serum CYFRA21-1 level increased (HR=1.217, 95%CI: 1.042-1.420, P=0.013) were all independent risk factors for recurrence within 2 years after modified radical hysterectomy in patients with cervical cancer. ④ The C-index of the nomogram prediction model of recurrence risk within 2 years after modified radical resection of cervical cancer was 0.874. The calibration curve showed that the prediction results of the nomogram were consistent with the observation results. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the prediction model was 0.874.

Conclusion

Cervical cancer patients with IGR have an increased risk of recurrence within 2 years after modified radical surgery.

Key words: Uterine cervical neoplasms, Impaired glucose regulation, Prediabetic state, Modified radical surgery, Recurrence, Female

图1 宫颈癌患者改良根治术后2年内复发风险曲线

表1 2组宫颈癌患者临床资料比较

组别	例数	年龄(岁，±s)	有吸烟史[例数(%)]	肿瘤FIGO分期[例数(%)]		肿瘤最大径>3 cm[例数(%)]	肿瘤病理级别[例数(%)]
组别	例数	年龄(岁，±s)	有吸烟史[例数(%)]	ⅠB	ⅡA	肿瘤最大径>3 cm[例数(%)]	高级别	低级别
复发组	20	54.2±6.0	5(25.0)	5(25.0)	15(75.0)	13(65.0)	12(60.0)	8(40.0)
未复发组	86	56.2±5.6	13(15.1)	55(64.0)	31(36.0)	41(47.7)	36(41.9)	50(58.1)
统计量		t＝1.40	χ²＝0.53	χ²＝10.02		χ²＝1.95	χ²＝2.15
P值		0.165	0.466	0.002		0.163	0.142
组别	例数	LVSI[例数(%)]	肿瘤病理类型[例数(%)]		肿瘤侵犯宫颈间质深1/3[例数(%)]	切缘阳性[例数(%)]	宫旁组织浸润阳性[例数(%)]	术后放疗[例数(%)]
组别	例数	LVSI[例数(%)]	鳞癌	腺癌	肿瘤侵犯宫颈间质深1/3[例数(%)]	切缘阳性[例数(%)]	宫旁组织浸润阳性[例数(%)]	术后放疗[例数(%)]
复发组	20	12(60.0)	4(20.0)	16(80.0)	13(65.0)	11(55.0)	14(70.0)	6(30.0)
未复发组	86	23(26.7)	17(19.8)	69(80.2)	30(34.9)	55(64.0)	36(41.9)	39(45.4)
统计量		χ²＝8.11	χ²＝0.08		χ²＝6.40	χ²＝0.55	χ²＝5.16	χ²＝1.56
P值		0.004	0.773		0.013	0.457	0.023	0.211
组别	例数	IGR[例数(%)]	血清SCC水平(ng/mL，±s)	血清CEA水平(μg/L，±s)	血清CA₁₂₅水平(U/L，±s)	血清CA₁₉₉水平(U/mL，±s)	血清CYFRA21-1水平(ng/mL，±s)
复发组	20	17(85.0)	17.8±3.0	18.6±2.9	85.3±8.3	78.3±8.5	15.3±2.6
未复发组	86	41(47.7)	15.9±2.6	20.1±3.4	82.2±9.5	81.3±8.1	13.5±2.2
统计量		χ²＝9.12	t＝2.87	t＝1.84	t＝1.30	t＝1.44	t＝2.96
P值		0.003	0.014	0.069	0.196	0.153	0.004

表1 2组宫颈癌患者临床资料比较

组别	例数	年龄(岁，±s)	有吸烟史[例数(%)]	肿瘤FIGO分期[例数(%)]		肿瘤最大径>3 cm[例数(%)]	肿瘤病理级别[例数(%)]
组别	例数	年龄(岁，±s)	有吸烟史[例数(%)]	ⅠB	ⅡA	肿瘤最大径>3 cm[例数(%)]	高级别	低级别
复发组	20	54.2±6.0	5(25.0)	5(25.0)	15(75.0)	13(65.0)	12(60.0)	8(40.0)
未复发组	86	56.2±5.6	13(15.1)	55(64.0)	31(36.0)	41(47.7)	36(41.9)	50(58.1)
统计量		t＝1.40	χ²＝0.53	χ²＝10.02		χ²＝1.95	χ²＝2.15
P值		0.165	0.466	0.002		0.163	0.142
组别	例数	LVSI[例数(%)]	肿瘤病理类型[例数(%)]		肿瘤侵犯宫颈间质深1/3[例数(%)]	切缘阳性[例数(%)]	宫旁组织浸润阳性[例数(%)]	术后放疗[例数(%)]
组别	例数	LVSI[例数(%)]	鳞癌	腺癌	肿瘤侵犯宫颈间质深1/3[例数(%)]	切缘阳性[例数(%)]	宫旁组织浸润阳性[例数(%)]	术后放疗[例数(%)]
复发组	20	12(60.0)	4(20.0)	16(80.0)	13(65.0)	11(55.0)	14(70.0)	6(30.0)
未复发组	86	23(26.7)	17(19.8)	69(80.2)	30(34.9)	55(64.0)	36(41.9)	39(45.4)
统计量		χ²＝8.11	χ²＝0.08		χ²＝6.40	χ²＝0.55	χ²＝5.16	χ²＝1.56
P值		0.004	0.773		0.013	0.457	0.023	0.211
组别	例数	IGR[例数(%)]	血清SCC水平(ng/mL，±s)	血清CEA水平(μg/L，±s)	血清CA₁₂₅水平(U/L，±s)	血清CA₁₉₉水平(U/mL，±s)	血清CYFRA21-1水平(ng/mL，±s)
复发组	20	17(85.0)	17.8±3.0	18.6±2.9	85.3±8.3	78.3±8.5	15.3±2.6
未复发组	86	41(47.7)	15.9±2.6	20.1±3.4	82.2±9.5	81.3±8.1	13.5±2.2
统计量		χ²＝9.12	t＝2.87	t＝1.84	t＝1.30	t＝1.44	t＝2.96
P值		0.003	0.014	0.069	0.196	0.153	0.004

表2 宫颈癌患者改良根治术后2年内复发的影响因素分析

影响因素	B	SE	Wald值	P值	HR值	HR值95%CI
IGR(vs NGT)	1.468	0.660	4.954	0.026	4.342	1.192～15.820
FIGO ⅡA期(vs ⅠB期)	1.333	0.540	6.095	0.014	3.794	1.316～10.935
LVSI(vs否)	1.104	0.498	4.920	0.027	3.017	1.137～8.007
肿瘤侵犯宫颈间质深1/3(vs否)	0.191	0.530	0.130	0.719	1.210	0.429～3.417
宫旁组织浸润阳性(vs阴性)	0.487	0.542	0.810	0.368	1.628	0.563～4.708
血清SCC水平(连续变量)	0.223	0.106	4.416	0.036	1.250	1.015～1.538
血清CYFRA21-1水平(连续变量)	0.196	0.079	6.163	0.013	1.217	1.042～1.420

表2 宫颈癌患者改良根治术后2年内复发的影响因素分析

影响因素	B	SE	Wald值	P值	HR值	HR值95%CI
IGR(vs NGT)	1.468	0.660	4.954	0.026	4.342	1.192～15.820
FIGO ⅡA期(vs ⅠB期)	1.333	0.540	6.095	0.014	3.794	1.316～10.935
LVSI(vs否)	1.104	0.498	4.920	0.027	3.017	1.137～8.007
肿瘤侵犯宫颈间质深1/3(vs否)	0.191	0.530	0.130	0.719	1.210	0.429～3.417
宫旁组织浸润阳性(vs阴性)	0.487	0.542	0.810	0.368	1.628	0.563～4.708
血清SCC水平(连续变量)	0.223	0.106	4.416	0.036	1.250	1.015～1.538
血清CYFRA21-1水平(连续变量)	0.196	0.079	6.163	0.013	1.217	1.042～1.420

图2 宫颈癌改良根治术后2年内复发风险的列线图预测模型、校准曲线及ROC曲线(图2A:预测模型；图2B:校准曲线；图2C: ROC曲线)注：FIGO为国际妇产科联盟，LVSI为淋巴脉管浸润，SCC为鳞癌抗原，CYFRA21-1为细胞角蛋白19片段。ROC曲线为受试者工作特征曲线

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