局部中晚期宫颈癌同步放化疗临床疗效及预后影响因素分析

摘要

目的 探讨局部中晚期宫颈癌单纯放疗与同步放化疗(CCRT)的临床疗效,分析预后的影响因素.方法 选取2008年9月—2013年12月中南大学湘雅二医院肿瘤中心收治的经病理确诊,并接受放化疗的125例局部中晚期宫颈癌患者.根据不同治疗方式分为单纯放疗27例(21.6%)(放疗组),CCRT 98例(78.4%)(CCRT组).随访截至2016-03-01,记录其总生存时间.Kaplan-Meier法绘制生存曲线,采用Log-rank进行检验;预后影响因素分析采用多元Cox比例风险回归模型.结果 125例患者1、3、5年生存率分别为89.6%、74.4%、71.2%.放疗组与CCRT组患者1、3、5年生存率比较,差异有统计学意义(P<0.05).放疗组与CCRT组患者骨髓抑制、胃肠道反应、直肠反应、泌尿生殖道反应、阴道炎症、盆腔积液、放射性肠炎、放射性膀胱炎、下肢静脉栓塞发生率比较,差异无统计学意义(P>0.05).Log-rank检验显示,国际妇产科联盟(FIGO)临床分期、治疗前血红蛋白水平、完成放疗总时间、不同治疗方案的局部中晚期宫颈癌患者总生存时间比较,差异均有统计学意义(P<0.05).多元Cox比例风险回归分析结果显示,FIGO临床分期〔HR=0.329,95%CI(0.106,0.770)〕、治疗前血红蛋白水平〔HR=0.937,95%CI(0.925, 0.984)〕、完成放疗总时间〔HR=1.081,95%CI(1.022,1.095)〕、治疗方案〔HR=0.203,95%CI(0.072,0.574)〕与局部中晚期宫颈癌患者总生存时间有回归关系(P<0.05).结论 局部中晚期宫颈癌CCRT临床疗效比单纯放疗有明显的优势.FIGO临床分期、治疗前血红蛋白水平、完成放疗总时间、治疗方案是局部中晚期宫颈癌患者预后的影响因素.%Objective To investigate the clinical efficacy as well as toxicity and side effects of simple radiotherapy and concurrent chemoradiotherapy(CCRT) for local advanced cervical cancer and analyze the influence of different factors on the prognosis.Methods A total of 125 cases with local advanced cervical cancer from September 2008 to December 2013 with a confirmed pathologic diagnosis who underwent chemoradiotherapy in the Cancer Center at the Second Xiangya Hospital of Central South University were selected.Based on different treatment methods,the patients were classified into radiotherapy(n=27, 21.6%) and CCRT(n=98,78.4%) groups.The overall survival(OS) for each patient was recorded at follow-up March 1,2016.The survival curve was drawn with the Kaplan-Meier method and a Log-rank test was performed.A multivariate Cox proportional hazards regression model was applied to analyze the prognostic factors.Results The general 1-,3-,and 5-year survival rates of the 125 patients were 89.6%,74.4%,and 71.2%,respectively.The difference of 1-,3-,and 5-year survival rates between the radiotherapy and CCRT groups was statistically significant(P<0.05).The incidence rates of patients with bone marrow suppression,gastrointestinal reactions,rectal reactions,genitourinary reactions,vaginal inflammation,pelvic fluid,radiation enteritis,radiation cystitis,and lower limb venous thrombosis did not exhibit significant differences between the two groups(P>0.05).The results of the Log-rank test showed that there were significant differences in the total OS of patients with local advanced cervical cancer by comparing FIGO clinical stage,pretreatment hemoglobin level,total duration of radiotherapy,and different treatment methods(P<0.05).Multivariate Cox hazards regression analysis illustrated that FIGO clinical stage〔HR=0.329,95%CI(0.106,0.770)〕,pretreatment hemoglobin level〔HR=0.937,95%CI(0.925,0.984)〕, total duration of radiotherapy〔HR=1.081,95%CI(1.022,1.095)〕,and treatment methods 〔HR=0.203,95%CI(0.072,0.574)〕exhibited regression correlations with the total OS of patients with local advanced cervical cancer(P<0.05).Conclusion Compared with radiotherapy treatment of patients with local advanced cervical cancer,the CCRT have obvious effects.FIGO clinical stage,pretreatment hemoglobin level,total duration of radiotherapy,and treatment methods are important prognostic factors for treatment of patients with local advanced cervical cancer.