| Nie Bin,Yu Jingping,Sun Wei,et al.Impacts of treatment modes on the prognosis of ⅠB1-ⅡA patients with intermediate-risk recurrence factors[J].Chinese Journal of Radiological Medicine and Protection,2021,41(11):818-823 |
| Impacts of treatment modes on the prognosis of ⅠB1-ⅡA patients with intermediate-risk recurrence factors |
| Received:May 16, 2021 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.11.004 |
| KeyWords:Uterine cervical neoplasm Risk factors Intensity-modulated radiotherapy Concurrent chemoradiotherapy Prognosis |
| FundProject: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） |
| Author Name | Affiliation | E-mail | | Nie Bin | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Yu Jingping | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Sun Wei | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Jing Fei | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Chen Guangzong | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Li Dongqing | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Hu Lijun | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Sun Zhiqiang | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Li Yi | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | | | Ni Xinchu | Department of Radiation Oncology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China | nixinchu@163.com |
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| Abstract:: |
| 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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