中晚期子宫颈癌患者调强放疗的疗效及预后影响因素分析

摘要

目的 探讨中晚期(Ⅱ～Ⅳ期)子宫颈癌患者调强放疗的疗效,并分析影响患者预后的相关因素.方法 收集2007年7月至2012年7月间在广西医科大学附属肿瘤医院妇瘤科治疗的Ⅱ～Ⅳ期子宫颈癌患者共218例,其中调强放疗94例(调强组),常规放疗124例(常规组).(1)采用x2检验比较两组患者的近期疗效,秩和检验比较两组患者的1、3、5年生存率及放疗副反应发生率；(2)采用log-rank检验、多重线性回归分析方法和Cox比例风险模型对影响患者预后的因素分别进行单因素和多因素分析.结果 (1)调强组患者的有效率为95.7％(90/94),常规组为86.3％(107/124),两组比较,差异有统计学意义(P＜0.01).调强组患者1、3、5年的总生存率分别为87.6％、73.4％、72.3％,常规组分别为90.1％、81.5％、75.7％,两组分别比较,差异均无统计学意义(P＞0.05).调强组患者急性消化系统反应、Ⅱ度及以上急性骨髓抑制的发生率分别为41.5％(39/94)、76.6％(72/94),常规组分别为42.7％(53/124)、78.2％ (97/124),两组分别比较,差异均有统计学意义(P＜0.01)；而调强组患者的急性泌尿系统反应的发生率[12.8％(12/94)]与常规组[8.1％(10/124)]比较,差异无统计学意义(P =0.248).调强组患者的晚期消化系统反应、泌尿系统反应和Ⅱ度及以上骨髓抑制的发生率分别为18.1％ (17/94)、16.0％(15/94)、25.5％(24/94),低于常规组的91.9％(114/124)、47.6％(59/124)、56.4％(70/124),两组分别比较,差异均有统计学意义(P＜0.01).(2)log-rank单因素分析显示,临床分期、病理分级、肿瘤直径与子宫颈癌患者的5年无瘤生存率和5年总生存率显著相关(P＜0.05)；多重线性回归多因素分析显示,临床分期、病理分级与子宫颈癌患者的5年总生存率显著相关(P＜0.01)；Cox比例风险模型多因素分析显示,临床分期、病理分级是影响子宫颈癌患者5年总生存率的独立因素(P＜0.01).结论 中晚期子宫颈癌患者调强放疗可以降低其放疗副反应的发生率,改善其生命质量,但没有改善患者的5年生存率.%Objective To investigate the efficacy of intensity-modulated radiation therapy(IMRT)and the prognosis factors in advanced cervical cancer.Methods A total of 218 cases of cervical cancer patients treated in Affiliated Tumor Hospital,Guangxi Medical University,between July 2007 and July 2012,were divided into IMRT group and routine radiotherapy group (conventional group,94 vs 124 cases).To compare the short-term effects of two groups by Chi-square test,and the incidence rate of 1,3,5-year survival by rank sum test ; to compare the acute and chronic toxicity of the two groups by rank sum test.And to analysis prognostic factors by log-rank test and Cox proportional hazard model and multiple linear regression analysis.Results (1) The effective rate in IMRT group was 95.7％ (90/94),which in the conventional group was 86.3％ (107/124; P ＜0.01).The 1,3,5-year overall survival rates in IMRT group were not significant difference than those in conventional group (87.6％ vs 90.1％,73.4％ vs 81.5％,and 72.3 ％ vs 75.7％ ;all P ＞ 0.05).The rate of acute gastrointestinal toxicity was 41.5 ％ (39/94) in IMRT group,vs 42.7％ (53/124) in conventional group(P ＜ 0.01); and the incidence of acute hematopoietic toxicity in IMRT group was 76.6％ (72/94),which was 78.2％ (97/124) in conventional group (P ＜0.01) ; the incidence of acute genitourinary toxicity was 12.8％ (12/94) in IMRT and 8.1％ (10/124) in conventional group(P =0.248).The late gastrointestinal,genitourinary and hematopoietic toxicities were 18.1％ (17/94),16.0％ (15/94) and 25.5％ (24/94),which were lower than those in conventional group 91.9％ (114/124),47.6％ (59/124) and 56.4％ (70/124),respectively (all P ＜0.01).(2) Univariate analysis showed that the International Federation of Gynecology and Obstetrics (FIGO) stage,histological grade and tumor size were closely associated with 5 years disease-free survival rates and overall survival rates (all P ＜ 0.05).Multivariate analysis showed that FIGO stage and histological grade were closely associated with 5 year overall survival rates (all P ＜ 0.01).FIGO stage and histological grade were independent factors to patients' 5-year overall survival rates in cervical cancer (P ＜0.01).Conclusion IMRT would be to reduce the acute and chronic toxicity,and to improve the quality of patients' life,but did not improve the 5 years survival rate in advanced cervical carcinoma.