摘要目的:分析年轻宫颈癌患者的临床特征、术后复发及影响预后的相关因素。方法:回顾性分析青岛大学附属医院2004年1月至2019年3月的宫颈癌住院患者的临床资料，选取≤35岁的243例年轻宫颈癌患者作为研究组，采用病例对照研究的方法，同期随机选取每月收治的年龄>35岁的第1、2例宫颈癌患者250例作为对照组。将两组患者的临床资料进行比较，分析两组患者的生存曲线。对比研究组中术后复发（17例）和未复发（164例）患者的临床资料，并对影响年轻宫颈癌患者预后的相关资料进行单因素和多因素分析。计数资料的比较采用χ 2检验或精确概率法，采用Kaplan-Meier法估计患者生存率和绘制生存曲线，生存率比较采用Long-Rank检验。运用Cox回归模型进行多因素分析。 结果:与对照组相比，年轻宫颈癌患者结婚、初潮年龄较早，孕、产次较少，未进行术前辅助治疗、神经浸润、保留卵巢较多，差异有统计学意义（χ 2值分别为94.58、67.54、60.53、5.44、13.64、5.51、118.24； P值分别为<0.001、<0.001、<0.001、0.025、0.003、0.022、<0.001）。研究组患者阴道不规则流血比例［13.17%（32/243）］低于对照组［30.40%（76/250）］，接触性阴道出血比例［52.26%（127/243）］高于对照组［43.20%（108/250）］，两组比较差异均有统计学意义（χ 2值分别为21.39、4.06； P值分别为<0.001、0.044）。研究组和对照组Kaplan-Meier生存率比较差异无统计学意义（χ 2=0.03， P=0.859）。单因素分析表明，国际妇产科学联合会（International Federation of Gynecology and Obstetrics，FIGO）分期、是否保留卵巢、宫颈浸润深度、神经浸润、淋巴血管间隙浸润和盆腔淋巴结转移是影响年轻宫颈癌患者5年生存率的影响因素（ P值分别为0.016、0.008、0.014、0.017、0.004、<0.001），而多因素分析表明FIGO分期（ OR=2.073，95% CI：1.017~4.228， P=0.045）、淋巴血管间隙浸润（ OR=0.041，95% CI：0.005~0.341， P=0.019）和盆腔淋巴结转移（ OR=0.027，95% CI：0.004~0.197， P<0.001）是影响年轻宫颈癌预后的危险因素。FIGO分期低、未发生淋巴血管间隙浸润和盆腔淋巴结转移者预后好。 结论:年轻宫颈癌患者中，首发临床特征以接触性阴道流血为主；年轻宫颈癌患者的预后及5年生存率与对照组比较差异无统计学意义，FIGO分期晚、不保留卵巢、宫颈浸润深度深、有神经、淋巴血管间隙浸润和盆腔淋巴结转移时年轻宫颈癌患者预后差，并以FIGO分期、淋巴血管间隙浸润和盆腔淋巴结转移影响最为显著。

abstractsObjective:To analyze the clinical features, postoperative recurrence and prognostic factors of young patients with cervical cancer.Methods:The clinical data of hospitalized cervical cancer patients in the Affiliated Hospital of Qingdao University from January 2004 to March 2019 were retrospectively studied. 243 young cervical cancer patients ≤35 years old were selected as the study group. The method of case-control study was adopted. In the same period, 250 first and second cervical cancer patients aged >35 years were randomly selected as the control group. The clinical data of the two groups were compared, and the survival curves of the two groups were analyzed. The clinical data of patients with postoperative recurrence (17 cases) and patients without recurrence (164 cases) in the study group were compared, and the related data affecting the prognosis of young cervical cancer patients were analyzed by univariate and multivariate analysis. Statistical data were compared by χ 2 test or exact probability method. Kaplan-meier method was used to estimate survival rate and draw survival curve. Survival rate was compared by Long-Rank test. COX regression model was used for multivariate analysis. Results:Compared with the control group, the young cervical cancer patients had earlier age of marriage, menstruate, fewer pregnancies, no preoperative adjuvant therapy, more nerve infiltration and ovarian preservation, the difference was statistically significant (χ 2 values were 94.58, 67.54, 60.53, 5.44, 13.64, 5.51, and 118.24, respectively; P values were <0.001, <0.001, <0.001, 0.025, 0.022, <0.001, respectively). The proportion of irregular vaginal bleeding in study group (13.17%(32/243)) was lower than that in control group (30.40%(76/250)), and the proportion of contact vaginal bleeding (52.26%(127/243)) was higher than that in control group (43.20%(108/250)). There were significant differences between the two groups (χ 2 values were 21.39 and 4.06, respectively; P values were < 0.001 and 0.044, respectively). There was no significant difference in Kaplan-Meier survival rate between the study group and the control group (χ 2=0.03, P=0.859). Univariate analysis showed that the International Federation of Gynecology and Obstetrics(FIGO), whether to retain ovary, depth of cervical invasion, nerve invasion, lymphatic vascular space invasion and pelvic lymph node metastasis were the influencing factors of 5-year survival rate of young cervical cancer patients ( P values were 0.016, 0.008, 0.014, 0.017, 0.004, <0.001, respectively). Multivariate analysis showed FIGO staging ( OR=2.073, 95% CI: 1.017-4.228, P=0.045), lymphatic vascular space infiltration ( OR=0.041, 95% CI: 0.005-0.341, P=0.019) and pelvic lymph node metastasis ( OR=0.027, 95% CI: 0.004-0.197, P<0.001) were risk factors affecting the prognosis of young cervical cancer. The patients with low FIGO stage, no lymphatic vascular space infiltration and pelvic lymph node metastasis have a good prognosis. Conclusion In young patients with cervical cancer, the first clinical feature is mainly contact vaginal bleeding. The prognosis of young patients with cervical cancer and 5 years survival rate there was no statistically significant difference compared with control group. The later FIGO staging , no ovarinan retention and the deeper cervical infiltration depth , with the nerve or between lymphatic vascular invasion and pelvic lymph node metastasis in young patients with cervical cancer had poor prognosis, and FIGO stage, lymphatic vessel space invasion and pelvic lymph node metastasis were the most significant factors.