A total of 689 patients who underwent QM-C hysterectomy for cervical cancer at the referral center between January 2012 and March 2015 and met the enrollment criteria were approached for the study, among which 181 patients consented for participation by signing the Informed Consent Form and being enrolled for pelvic floor function screening. Of the 181 patients, 170 completed data of pelvic floor function examinations for both type I and type ⅡA MFS (see Fig. 2) .
Table 1 describes the age, body mass index, parity, mode of baby production, FIGO staging, treatment type, and the postoperative follow-up time of the enrolled patients (see Table 1). Of the 181 enrolled patients, 22.1% (40) were detected as level 0, 30.5% (55) as level 1–3, and 47.4% (86) as level 4–5 of type I MFS, while 15.3% (28) of them were detected as level 0, 34.7% (63) as level 1–3, and 50% (90) as level 4–5 of type IIA MFS. The interviewing to those patients shows that 46% (83) of them had SUI, 27.3% (49) had UR, 41.5% (75) had dyschezia, and 9% (16) suffered fecal incontinence; 77.5% of the patients were not satisfied with their sexual life. All these data suggests that the therapy of cervical cancer they underwent have significant negative influences on patients’ pelvic function, and PFMS is an important pelvic floor function indicator to assess that influences (See Table 2).
Univariate analyses to the risk factors of the 181 enrolled patients showed that the type I muscle fiber strength (MFS-I) of Group SR was significantly worse than Group-S (Group-SR vs Group-S, est 0.203, 95% CI 0.071–0.577, p = 0.003), and that MFS-I of the patients who were 18–24 months after operations was significantly better than that of the patients who were 3–6 months after surgery (18-24months vs 3-6months, est 2.539, 95% CI 1.077–5.987, p = 0.033); the type IIA muscle fiber strength (MFS-IIA) of the patients in Group-SR was significantly worse than those in Group-S (Group-SR vs Group-S, est 0.333, 95% CI 0.119–0.931, p = 0.036) (Table 3). Results from univariate analyses suggest that multiple therapies have negative impact on MFS-I and MFS-IIA and recovery time helps MFS recovery.
We also performed multivariate regression analysis on each of the factors as: postoperative period and treatment methods. After excluding confounding factors, we found that MFS-I of Group-SR were significantly worse than that of Group-S ( Group-SR vs Group-S, est 0.230, 95% CI 0.072–0.738, p = 0.013); and the muscle strength of patients in Group-SRC was significantly worse than that of the patients in Group-S ( Group-SRC vs Group-S, est 0.428, 95% CI 0.192–0.954, p = 0.038). Muscle strength in Group SC was different with that of Group-S but not statistically significant ( Group SC vs Group-S, est 0.602, 95% CI 0.388–1.731, P = 0.602). Results from multivariate regressive analyses also suggest the negative impacts of multiple therapies on MFS-I and MFS-IIA recovery.
In comparing the MFS of the patients with different post-treatment periods (PTP), patients with PTP of 18–24 months, 12-18months and 9–12 months are all significantly worse than patients with a PTP of 3–6 months (18–24 mths vs 3-6m, est 3.126, 95% CI 1.278–7.647, p = 0.013; 12-18mths vs 3-6m, est 3.194, 95% CI 1.339–7.617, p = 0.009; and 9–12 mths vs 3–6 mths, est 3.816, 95% CI 1.095–13.302, p = 0.036, respectively). However, patients with a PTP of 6–9 months is not significantly worse and those with a PTP of 3–6 (6-9m vs 3-6m, est 1.592, 95% CI 0.641–3.954, p = 0.316). This result suggests a time-base trends of MFS which is the longer the PTP is, the worse the MSF is.
The results also show that MFS-ⅡA of the patients in Group-SR was better than that of patients in Group-S with no statistical significance (Group-SR vs Group-S, est 0.318, 95% CI 0.100-1.009, p = 0.052), although the P value is close to 0.05. It was suggested that radiotherapy might be a risk factor for type II pelvic floor muscle fibers .
When comparing MFS-IIA of the patients with different PTPs, patients with a PTP of 18-24mths, 12-18mths, 9-12mths, and 6-9mths are all better than patients with PTP of 6-9mths, but significant differences only exist in the comparisons between patients with PTP of 12-18mths and those with PTP of 3-6mths (12-18m vs 3-6m, est 2.385, 95% CI 1.007–5.649, p = 0.048) and that between patients with a PTP of 9-12mths and those with PTP of 3-6mths (9-12m vs 3-6m, est 5.178, 95% CI 1.454–18.445, p = 0.011), with no difference shows in comparisons between patients with PTP of 18–24 and those with PTP of 3–6 (18-24m vs 3-6m, est 1.981, 95% CI 0.815–4.815, p = 0.131) and that between patients with PTP of 6–9 and those with PTP of 3–6 (6-9m vs 3-6m, est 1.257, 95% CI 0.505–3.126, p = 0.623) (See Table 4). Those results suggest that most of the MFS-IIA recovery may took place in 9–12 months of PTP.