Investigation And Analysis Of Cervical Cancer Recurrence Based On Clinical Diagnosis And Treatment Database Of Cervical Cancer In China

In recent years,although the diagnosis and treatment of cervical cancer is standardized,a considerable number of patients still suffer from recurrence.Recurrence of cervical cancer is generally defined as the recurrence of cervical cancer after radical treatment with the same histopathological type as before treatment.But in clinical practice,persistent tumor,as a special case of recurrence,means that the disease situation is not controlled in the process of treatment.It is difficult to distinguish the two in clinical practice.Therefore,this study will focus on patients with uncontrolled and recurrent cervical cancer.Recurrence is the first cause of death in patients with cervical cancer,which is related to the extremely difficult treatment.Therefore,the early prediction of recurrence of cervical cancer and the choice of treatment after recurrence are particularly important for improving the overall prognosis of patients with cervical cancer.Due to the great differences in medical and health conditions in different regions,there are also great differences in the reports of recurrence rate of cervical cancer in different studies.The recurrence rate of early cervical cancer is mostly between 4%and 13.1%,while the recurrence rate of late cases can be as high as 70.0%.However,there are some problems in the research of recurrent cervical cancer at home and abroad,such as large research time span,single center,small sample size and so on.In clinical practice,the survival prognosis of patients with recurrent cervical cancer is more concerned.Previous studies on the prognostic factors of recurrent cervical cancer found that for patients with recurrent cervical cancer,recurrence after 2 years of initial treatment,tumor diameter<4cm,negative margin and lymph node,and surgical treatment after recurrence all predict better survival outcomes,There are also some studies that for patients with cervical cancer who have a history of radiotherapy,the recurrence cases in the radiation field have better survival outcomes after recurrence.Some studies have found that the sensitivity of patients with recurrent cervical cancer to chemotherapy is lower than that of ordinary patients,but some scholars believe that the low response rate of patients with recurrent cervical cancer is related to treatment-related anemia and complications,and the high response rate is not completely equivalent to a better prognosis.Therefore,in the second and third parts of this paper,the 3-year survival rate of patients with recurrent cervical cancer was taken as the main observation index to explore the influencing factors of the survival of patients with recurrent cervical cancer and the long-term prognosis of preoperative neoadjuvant chemotherapy for patients with cervical cancer.In clinical practice,the survival prognosis of patients with recurrent cervical cancer is more concerned.Previous studies on the prognostic factors of recurrent cervical cancer found that for patients with recurrent cervical cancer,recurrence after 2 years of initial treatment,tumor diameter<4cm,negative margin and lymph node,and surgical treatment after recurrence all predict better survival outcomes,There are also some studies that for patients with cervical cancer who have a history of radiotherapy,the recurrence cases in the radiation field have better survival outcomes after recurrence.Some studies have found that the sensitivity of patients with recurrent cervical cancer to chemotherapy is lower than that of ordinary patients,but some scholars believe that the low response rate of patients with recurrent cervical cancer is related to treatment-related anemia and complications,and the high response rate is not completely equivalent to a better prognosis.Therefore,in the second and third parts of this paper,the 3-year survival rate of patients with recurrent cervical cancer was taken as the main observation index to explore the influencing factors of the survival of patients with recurrent cervical cancer and the long-term prognosis of preoperative neoadjuvant chemotherapy for patients with cervical cancer.The choice of treatment for patients with recurrent cervical cancer is a great challenge in clinical work.Because of the existence of anatomical variation,tissue adhesion,radiation injury and low immune function after operation or radiotherapy,the treatment of recurrent cervical cancer is extremely difficult.At present,the choice of treatment for patients with recurrent cervical cancer after recurrence mostly considers the initial treatment,the recurrence site and the overall state of the patient.Therefore,the optimal treatment for patients with recurrent cervical cancer in different situations is also an important issue.In order to solve the above problems,based on the database of Chinese cervical cancer clinical diagnosis and treatment project,this study investigated the recurrence of cervical cancer patients in some areas of China,the survival situation and influencing factors of recurrent cervical cancer after recurrence Objective to explore the influence of preoperative neoadjuvant chemotherapy on the prognosis of patients with recurrent cervical cancer whose initial treatment is surgery and the treatment options of patients with recurrent cervical cancer under different conditions.Capture1 Investigation and analysis of cervical cancer recurrence in China[Objective]To retrospectively investigate the proportion and recurrence pattern of patients with recurrent cervical cancer under different clinicopathological characteristics.[Methods]Based on the Chinese cervical cancer clinical diagnosis and treatment project database,we retrospectively analyzed the proportion of recurrent cases of 44880 cervical cancer patients with survival outcomes under different clinicopathological characteristics,and further studied the differences of recurrence location and recurrence time under different conditions.[Results](1)A total of 44880 cases were included in this part,of which 7286 cases recurred,and the overall recurrence rate was 16.2%(2)With the development of figo2009,the proportion of recurrent cases increased.The proportion of recurrent cases in ⅠA stage was only 2.8%(81/2905),ⅠB stage was 10.2%(1768/17251),ⅡA stage was 16.6%(1548/9346),Ⅱb stage was 21.6%(1263/5848),Ⅲ stage and Ⅳstage were 34.4%(1316/3826)and 52.5%(237/451),respectively.3%(220/727);3%(4335/22495),which was higher than 13.5%(2854/21134)in general hospitals and 7.8%(97/1251)in maternal and child hospitals,and 18.3%(1039/5681)in third tier and above cities(3)Histological type,hospital type and city grade did not affect the recurrence time of patients,but only affected the distribution of recurrence sites.Patients with special pathological type,late staging and visiting cancer hospital were more likely to have distant recurrence.[Conclusion]The later the clinical stage,the special pathological type,the higher the recurrence rate of cervical cancer patients in cancer hospitals and third tier cities,and the more distant recurrence.Chapter2 Analysis of factors influencing the survival of recurrent cervical cancer[Objective]To investigate the influence of different factors on the survival and prognosis of patients with recurrent cervical cancer.[Methods]Based on the Chinese cervical cancer clinical diagnosis and treatment project database,univariate and multivariate analysis were used to analyze the effects of age at first diagnosis,clinical stage(figo2009),histological type,initial treatment,recurrence site,recurrence time and treatment after recurrence on the 3-year survival rate(PRS)of patients with recurrent cervical cancer.[Results](1)In this part,7286 patients with definite recurrence were included.6792 patients were followed up after recurrence.The median follow-up time was 27 months(2)Kaplan Meier univariate analysis showed that the 3-year PRS of cervical cancer patients younger than 40 years old was better than that of cervical cancer patients older than or equal to 40 years old(13.6%vs 10.4%,P=0.001);The 3-year PRS of patients with squamous cell carcinoma was 11.2%,which was significantly higher than that of patients with recurrence of other pathological types;The 3-year PRS of patients with surgery as the initial treatment was 14.0%,which was significantly higher than that of patients with radical chemoradiotherapy(6.9%)(P<0.001);The 3-year PRS of cervical cancer patients with pelvic and distant recurrence was 20.6%,which was higher than 19.0%of local recurrence and 13.5%of distant recurrence;The 3-year survival rate of cervical cancer patients with recurrence time≤2 years was 19.4%,which was significantly higher than that of 7.7%with recurrence time>2 years(P<0.001);The 3-year PRS of patients treated with surgery+radiotherapy/chemoradiotherapy after recurrence was 24.6%,which was higher than that of patients treated with other treatments after recurrence(2)Multivariate analysis showed that special pathological type,radical radiotherapy and chemotherapy,local pelvic recurrence,recurrence time>2 years were independent risk factors for 3-year PRs in patients with recurrent cervical cancer.Active treatment after recurrence is an independent protective factor for the survival of patients with recurrent cervical cancer.[Conclusion]Special histological type of cervical cancer,radical radiotherapy and chemotherapy as initial treatment,distant recurrence and recurrence within 2 years are independent risk factors affecting the survival of patients with recurrent cervical cancer after 3 years of recurrence,while treatment after recurrence is an independent protective factor.Chapter3 Evaluate the effect of preoperative neoadjuvant therapy in patients with cervical cancer[Objective]To investigate whether preoperative neoadjuvant chemotherapy is beneficial to the long-term prognosis of patients with ⅠA1(LVSI+)-ⅡA2 cervical cancer.[Methods]Patients with ⅠA1(LVSI+)-ⅡA2 stage cervical cancer who underwent surgical treatment were included.The 5-year overall survival rate(OS),5-year disease-free survival rate(DFS),recurrence pattern and post recurrence survival rate(PRS)were retrospectively analyzed to explore whether neoadjuvant chemotherapy can benefit the patients with cervical cancer who underwent surgical treatment Benefit.[Results]A total of 12974 patients were included,including 10788 patients with direct surgery and 2186 patients with preoperative neoadjuvant chemotherapy.Our study found that patients with preoperative neoadjuvant chemotherapy were associated with lower 5-year disease-free survival.In multivariate analysis,preoperative neoadjuvant chemotherapy was not an independent risk factor for 5-year OS(P=0.072).In 12974 patients,1491 cases(11.5%)recurred.1176 cases(10.9%)were treated with direct surgery and 315 cases(14.4%)were treated with neoadjuvant chemotherapy before surgery.There was no significant difference in recurrence time and location between the two groups.According to the study of 1491 recurrent cases,the 3-year recurrence survival(PRS)rate of neoadjuvant chemotherapy group was lower than that of direct surgery group,but the difference was not statistically significant.[Conclusion]Preoperative neoadjuvant chemotherapy is associated with lower 5-year DFS,and patients with recurrence or uncontrolled cervical cancer before neoadjuvant chemotherapy have shorter recurrence time,but preoperative neoadjuvant chemotherapy does not affect the survival after recurrence.Chapter4 Treatment options for recurrent cervical cancer with different initial treatment and recurrence sites[Objective]Objective to compare the effect of several common post recurrence treatment schemes on the prognosis of patients with recurrent cervical cancer,and to provide basis for different cases of patients with recurrent cervical cancer to choose Post recurrence treatment.[Methods]In this part,we first selected all patients with recurrent cervical cancer,and compared the prognosis of several common treatment methods after recurrence(operation ± radiotherapy/chemoradiotherapy ± chemotherapy,radiotherapy/chemoradiotherapy,chemotherapy alone,no treatment).The survival after 3 years of recurrence was taken as the observation index.According to the combination of initial treatment and recurrence site,the optimal treatment strategy for different types of recurrent cervical cancer was obtained.[Results](1)For all patients with recurrent cervical cancer,surgery plus radiotherapy/chemoradiotherapy has the best prognosis,with a 3-year survival rate of 24.6%;(2)Radiotherapy/chemoradiotherapy is the most appropriate treatment for patients with pelvic local recurrence and surgery as the initial treatment;for patients with pelvic local recurrence and radical chemoradiotherapy as the initial treatment,all treatment methods are better than no treatment,but there is no statistical difference between the treatment schemes;for patients with distant recurrence and surgery as the initial treatment,all treatment methods are better It is better than no treatment,but there is no statistical difference between the treatment schemes;for the patients whose initial treatment is radical chemoradiotherapy and distant recurrence,radiotherapy/chemoradiotherapy is the most appropriate treatment;for the patients whose initial treatment is surgical treatment and pelvic + distant recurrence,radiotherapy/chemoradiotherapy is the most appropriate treatment;for the patients whose initial treatment is radical chemoradiotherapy and pelvic+distant recurrence,radiotherapy/chemoradiotherapy is the most appropriate treatment There was no significant difference in the prognosis between the two groups.[Conclusion]For the patients with pelvic local recurrence/pelvic+distant recurrence,radical radiochemotherapy and distant recurrence,radiotherapy/radiochemotherapy are the most appropriate treatment;for the patients with pelvic local recurrence and radical radiochemotherapy and surgical treatment and distant recurrence,all the schemes are better than no treatment,but there is no statistical difference between the two schemes.