Investigation And Analysis Of Postoperative Adjuvant Therapy Of Cervical Cancer In 34 Hosipitals Of Chinese Mainland In The Past 13 Years

Objective: In order to improve the standardization of cervical cancer treatment,we need to investigate and analyze the status and influencing factors of adjuvant therapy for cervical cancer with risk factors after radical hysterectomy in Chinese mainland.Methods: We retrospectively analyzed 6,536 cases of cervical cancer with risk factors after radical hysterectomy in 34 hospitals of 11 provinces and cities in Chinese mainland from January 2004 to December 2016.Patients were divided into the high-risk group(with more than one high risk factor)and the middle-risk group(with more than two intermediate risk factors),futhermore groups were stratified by postoperative adjuvant therapy.We used multivariable logistic regression to identify independent influencing factors.We focused on the independent influencing factors of postoperative chemotherapy alone because of its high proportion.Results:1.In cervical cancer patients with postoperative risk factors,patients aged 41-50 years were more common,rural patients were more than urban patients;squamous cell carcinoma was the leading pathology,most histological grades were moderate and poorly differentiated;the proportion of neoadjuvant chemotherapy was 28.9%;concurrent chemoradiotherapy accounted for only 8.8%,but the proportion of sequential chemoradiotherapy was as high as 36.7%,followed by chemotherapy alone,accounting for 24.1%.2.Lymph node metastasis was the most important risk factor for cervical cancer in the high-risk group;TD≥4cm and DSI≥1/2 was the most common combination of risk factors for cervical cancer in the middle-risk group.3.The proportion of cervical adenocarcinoma and adenosquamouscarcinoma in the high-risk group was significantly higher than that in the middle-risk group;the proportion of locally advanced cervical cancer and neoadjuvant chemotherapy in the middle-risk group was significantly higher than that in the high-risk group.4.The postoperative adjuvant treatment for cervical cancer with risk factors was closely associated with the type of hospital.5.Independent influencing factors for postoperative chemotherapy alone of cervical cancer were as followed.In the high-risk group,patients of hospitals in northern region,the Women’s and Children’s Hospital,adenocarcinoma and adenosquamou carcinoma,locally advanced and advanced cervical cancers tended to adopt chemotherapy alone(OR>1,risk factors of concurrent chemoradiotherapy);In the middle-risk group,patients of hospitals in northern region,the Women’s and Children’s Hospital,adenocarcinoma and adenosquamou carcinoma,≤30 years old,TD≥4cm tended to adopt chemotherapy alone(OR>1,risk factors of chemoradiotherapy).Conclusions:1.In cervical cancer patients with postoperative risk factors,incidence of cervical cancer tends to be younger,the proportion of rural patients is higher than urban patients.2.Cervical adenocarcinoma and adenosquamous carcinoma have a high risk of lymph node metastasis,locally advanced cervical cancer have a high risk of existing other intermediate risk factors after radical surgery.3.There are diversity and absence of standard in the postoperative adjuvant therapy for cervical cancer with risk factors in China,which tends to standardize over time.4.The postoperative adjuvant therapy of cervical cancer with risk factors in China is closely related to the types of hospital,the standardization from high to low is the Tumor Hospital,the General Hospital and the Women’s and Children’s Hospital.5.More young patients of cervical cancer who have intermediate risk factors are given postoperative chemotherapy alone.6.Compared with common squamous cell carcinoma,more patients of cervical adenocarcinoma and adenosquamous carcinoma with risk factors are given postoperative chemotherapy alone.7.More Patients of locally advanced or advanced cervical cancer with high-risk factors are given postoperative chemotherapy alone.