| 马建萍,潘闻燕,何剑莉,陆青,孟颖,冯阳阳,拜周兰.早期宫颈癌术后淋巴结阳性患者放疗后疗效及预后分析[J].中华放射医学与防护杂志,2022,42(8):584-589 |
| 早期宫颈癌术后淋巴结阳性患者放疗后疗效及预后分析 |
| Clinical effects and prognosis of radiotherapy for early cervical cancer patients with postoperative lymph node metastasis |
| 投稿时间：2022-03-21 |
| DOI：10.3760/cma.j.cn112271-20220321-00117 |
| 中文关键词: 早期宫颈癌术后 盆腔淋巴结转移 调强放疗 预后 |
| 英文关键词:Early cervical cancer after surgery Pelvic lymph node metastasis Intensity modulated radiotherapy Prognosis |
| 基金项目:河南省科技开放合作（18200003597） |
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| 中文摘要: |
| 目的 回顾性分析早期（Ⅰ B~Ⅱ A期）宫颈癌术后淋巴结阳性患者调强放疗（IMRT）后的预后及淋巴结转移的相关危险因素。方法 选取2016年1月至2018年12月宁夏医科大学总医院放疗科收治的292例早期宫颈癌术后存在高危因素和/或中危因素且行盆腹腔调强放疗±同步化疗的患者进行回顾性分析，分为盆腔淋巴结阴性组239例、淋巴结阳性组53例，对淋巴结转移的相关危险因素及两组患者的预后进行分析。结果 早期宫颈癌术后淋巴结转移影响因素的单因素及多因素分析显示，病变≥4 cm、深间质侵犯、危险因素个数是盆腔淋巴结转移的独立影响因素（χ2=7.11、9.05、90.08，P<0.05）；盆腔淋巴结阴性及阳性患者放疗后3、5年总生存（OS）差异无统计学意义（P>0.05），3、5年无疾病生存（DFS）两组分别为87.6%、84.5%；72.5%、69.3%（χ2=8.59，P=0.003）。在失败模式上，淋巴结阳性组以远处转移为主，淋巴结阴性组以局部复发为主（χ2=9.40，P<0.05）。对53例淋巴结阳性患者放疗后影响DFS的单因素分析，深间质侵犯明显影响患者的DFS，差异有统计学意义（χ2=7.25，P<0.05）；多因素分析提示病变>4 cm、残端阳性和深间质侵犯显著影响DFS （χ2=4.37、4.69、4.39，P<0.05）。结论 早期宫颈癌术后病变大小、侵犯深度、危险因素个数是淋巴结转移的独立影响因素，盆腔淋巴结阳性患者放疗后DFS显著低于淋巴结阴性患者，淋巴结阳性患者的主要复发模式为远处转移，深间质侵犯是早期宫颈癌术后淋巴结阳性患者放疗后DFS的独立影响因素。 |
| 英文摘要: |
| Objective To retrospectively analyze the prognosis and related risk factors of lymph node metastasis in early-stage (Ⅰ B-Ⅱ A) cervical cancer patients with postoperative positive lymph nodes who were treated with intensity modulated radiotherapy (IMRT).Methods A retrospective analysis was conducted for 292 early-stage cervical cancer patients with postoperative high and/or moderate risk factors who were treated with pelvic-abdominal IMRT with/without concurrent chemotherapy in Ningxia Medical University General Hospital from January 2016 to December 2018. These patients included 239 with negative pelvic lymph nodes and 53 with positive lymph nodes, who were incorporated into the negative group and the positive group, respectively. Multivariate and univariate analyses of the risk factors of lymph node metastasis and prognosis were performed for both groups.Results The univariate and multivariate analyses showed that the lesion ≥ 4cm, deep interstitial invasion, and the number of risk factors were independent factors influencing pelvic lymph node metastasis (χ2=7.11, 9.05, 90.08, P < 0.05). There was no statistically significant difference in the 3- and 5-year OS (P>0.05) between both groups. The 3-year disease-free survival (DFS) and 5-year DFS of the negative group were 87.6% and 84.5%, respectively, and those of the positive group were 72.5% and 69.3%, respectively (χ2=8.59, P=0.003). Regarding failure modes, distant metastasis mainly occurred in the positive group, while local recurrence was dominant in the negative group (χ2=9.40, P<0.05). The univariate analysis of the DFS in 53 patients with postoperative positive lymph nodes showed that deep interstitial invasion affected DFS, with statistically significant differences (χ2=7.25, P < 0.05). The result of the multivariate analysis showed that the lesion size >4 cm, positive residual, and deep interstitial invasion significantly influenced the DFS (χ2=4.37, 4.69, 4.39, P < 0.05).Conclusions The lesion size, deep interstitial invasion, and risk factor number were independent factors influencing lymph node metastasis, and the DFS after radiotherapy of patients with pelvic lymph node metastasis was significantly lower than the patients with negative lymph nodes. The main recurrence type of patients with lymph node metastasis was distant metastasis. Moreover, the deep interstitial invasion was independent factor affecting the DFS of early-stage cervical cancer patients with postoperative positive lymph nodes. |
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