D-二聚体水平对评估早期宫颈癌术后复发的临床价值

摘要

目的 探讨术前血浆D-二聚体(DD)水平对评估早期宫颈癌术后复发的临床价值.方法 选取2011年1月1日至2016年3月31日入住本科室的早期宫颈癌患者,根据术前血浆DD水平分为DD水平升高组(A组)和DD水平正常组(B组),并进行术后随访,以宫颈癌复发为随访的终点事件.采用Kaplan-Meier法计算生存率,采用Log-rank检验计算组间生存率曲线差异,采用多变量Cox比例风险回归分析早期宫颈癌术后复发的独立危险因素.结果 A组有16例复发,复发时间中位数为25.5个月(6 ～ 50个月),无复发生存率为74.0％;B组有11例复发,复发时间中位数为36个月(15 ～ 62个月),无复发生存率为88.8％.Kaplan-Meier曲线表明,A组无复发生存率明显低于B组(P＜0.05).多变量Cox比例风险回归分析发现,术前血浆DD水平、FIGO分期、淋巴结转移及治疗方法均为早期宫颈癌术后复发的独立危险因素.结论 术前血浆DD水平是早期宫颈癌术后复发的独立危险因素,且该指标对早期宫颈癌的指导治疗及判断预后具有更好的临床价值.%Objective To explore the clinical value of preoperative plasma D-dimer (DD) level for indicating the recurrence of early cervical cancer after operation.Methods Patients with early cervical cancer hospitalized into our hospital from January 1,2011 to March 31,2016 were selected and wee divided into an increased DD level group (group A) and a normal DD level group (group B) according to preoperative plasma DD level.The follow-up was carried out after surgery.The follow-up endpoint was cancer recurrence.Kaplan-Meier method was used to estimate survival rate.The survival difference between the two groups was compared using log-rank test.Multivariate Cox proportional hazards regression were used to determine the independent risk factors of cervical cancer recurrence.Results 16 cases recurred in group A,with a median time of 25.5 (6-50) months and a recurrence-free survival rate of 74.0％;11 cases recurred in group B,with a median time of 36.0 (15-62) months and a recurrence-free survival rate of 88.8％.Kaplan-Meier curve showed that recurrence-free survival rate was significantly lower in group A than group B (P ＜ 0.05).Multivariate Cox proportional hazards regression analysis showed that plasma DD level,FIGO stage,lymph node metastasis,and treatment method were the independent risk factors for cervical cancer recurrence.Conclusions Preoperative DD level is an independent risk factor affecting cervical cancer relapse,which help better guide treatment and prognosis assessment.