| 聂斌,于静萍,孙威,景飞,陈光宗,李栋庆,胡莉钧,孙志强,李毅,倪新初.ⅠB1~ⅡA具有中危复发因素的宫颈癌患者术后不同治疗模式对预后影响的分析[J].中华放射医学与防护杂志,2021,41(11):818-823 |
| ⅠB1~ⅡA具有中危复发因素的宫颈癌患者术后不同治疗模式对预后影响的分析 |
| Impacts of treatment modes on the prognosis of ⅠB1-ⅡA patients with intermediate-risk recurrence factors |
| 投稿时间：2021-05-16 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.11.004 |
| 中文关键词: 宫颈癌 危险因素 调强放射治疗 同步放化疗 预后 |
| 英文关键词:Uterine cervical neoplasm Risk factors Intensity-modulated radiotherapy Concurrent chemoradiotherapy Prognosis |
| 基金项目:国家重大研发计划（2019YFF01014405）；北京市医管局培育计划（PX2019042）；北京市自然科学基金（1202009）；国家自然科学基金（12005007） |
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| 中文摘要: |
| 目的 分析影响ⅠB1~ⅡA宫颈癌术后患者预后因素，评估调强放疗及联合同步化疗治疗模式的作用和不良反应。方法 回顾性分析2009年1月-2019年12月常州市第二人民医院收治362例ⅠB1~ⅡA宫颈癌术后符合1项或多项中危复发因素患者的临床资料和随访结果。362例患者中行同步放化疗161例，单纯放疗131例，未辅助放疗70例。采用Kaplan-Meier法和Log-rank检验进行单因素生存分析，采用二元logistic回归分析复发风险，采用Cox回归模型进行多因素生存分析。结果 全组患者3年、5年的总生存（OS）率分别为94.20%和88.39%。回归分析发现肿瘤≥ 4 cm和低分化癌是复发的风险因素（OR=3.287，2.870，95% CI：1.366~7.905，1.105~7.457，P<0.05）。同步放化疗较未辅助放疗和单纯放疗降低了肿瘤≥ 4 cm、病理类型为腺癌或腺鳞癌以及低分化癌者的复发率（χ2=6.725~7.518，P<0.05）；多因素分析显示，同步放化疗治疗模式改善患者的无复发生存期（HR=0.290，95% CI：0.128~0.659，P=0.003）和总生存期（HR=0.370，95% CI：0.156~0.895，P=0.024）。亚组分析显示同步放化疗较未辅助放疗或单纯放疗延长了肿瘤≥ 4 cm或低分化癌患者的OS（χ2=7.614、5.964，P<0.05）。同步放化疗较单纯放疗未增加3级以上血液学不良反应、放射性肠炎和膀胱炎的发生率（P>0.05）。结论 在宫颈癌中危复发风险病例中肿瘤体积大、分化程度低影响患者的预后。调强放疗联合同步化疗的治疗模式较单纯放疗和未辅助放疗可延长肿瘤体积大或低分化癌术后患者的无复发生存期和总生存期，不良反应可耐受。 |
| 英文摘要: |
| Objective To analyze the prognostic factors of patients with ⅠB1-ⅡA cervical cancers after surgery and to assess the effects and adverse reactions of intensity-modulated radiotherapy(IMRT)combined with concurrent chemotherapy(CCRT). Methods A retrospective analysis was performed based on the clinical and follow-up data of 362 patients with ⅠB1-ⅡA cervical cancers who were treated in Changzhou Second People's Hospital from January 2009 to December 2019. Meanwhile, these patients suffered large primary tumors(LPT; tumors size: ≥ 4 cm), lymphatic vascular space invasion (LVSI), and deep stromal invasion(DSI; stromal infiltration depth: ≥ 1/2) after surgery and showed at least one intermediate-risk factor. Among these cases, 161 cases were treated with CCRT, 131 cases under-went single radiotherapy (RT), and 70 cases received unadjuvanted radiotherapy. The Kaplan-Meier method and the logrank test were adopted for univariate survival analysis, the binary logistic regression was used to analyze the recurrence risk, and Cox regression model was used for multivariate survival analysis. Results The 3 and 5-year overall survival (OS) rates were 94.20% and 88.39%, respectively. The retrospective analysis showed that the risk factors of recurrence included tumor size ≥ 4 cm and poorly differentiated cancers(OR=3.287, 2.870, 95% CI: 1.366-7.905, 1.105-7.457, P<0.05). Compared with the treatment without adjuvant radiotherapy and RT, CCRT reduced the recurrence rate of tumors with tumor size of ≥ 4 cm, adenocarcinomas or adenosquamous carcinomas (pathological types), and poorly differentiated carcinomas(χ2=6.725-7.518, P<0.05). A multivariate analysis showed that the CCRT improved the recurrence-free survival (HR=0.290, 95% CI: 0.128-0.659, P=0.003) and OS (HR=0.370, 95% CI: 0.156-0.895, P=0.024). A subgroup analysis indicated that CCRT prolonged the OS of patients with tumor size ≥ 4 cm or poorly differentiated cancers compared to the patients receiving no radiotherapy or those treated with RT (χ2=7.614, 5.964, P<0.05). Compared with the cases receiving single radiotherapy, those receiving CCRT did not suffer an increase in the incidence of hematology, radiation enteritis, and cystitis above grade 3 according to observation (P>0.05). Conclusions Among the intermediate-risk factors leading to the recurrence of postoperative cervical cancers, the factors of large primary tumors or poorly differentiated cancers affect the prognosis of patients.Compared with RT and the treatment without adjuvant radiotherapy, IMRT combined with concurrent chemotherapy can prolong the recurrence-free survival and overall survival of patients with large tumors or poorly differentiated cancers and adverse reactions induced are tolerable. |
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