摘要
目的:分析比较根治性放疗联合双药同步化疗与新辅助化疗联合根治性子宫切除术加术后辅助放疗治疗FIGOⅡ_b 宫颈癌的复发转移率,无进展生存期(PFS),总生存期(OS),不良反应及预后影响因素。方法:回顾性分析2008年9月至2013年12月期间中南大学湘雅二医院肿瘤中心及妇科收治的初治FIGOⅡ_b 期宫颈癌患者,共计91例。按照治疗方式分为两组:(1)同步放化疗组49例:根治性放疗联合双药同步化疗,3周方案连续4至6周期;(2)新-术-放疗组42例:先予以2至3周期新辅助化疗,然后行根治性子宫切除及盆腔淋巴结清扫术加术后辅助放疗。比较两种治疗方式的疗效及不良反应有无差异,并通过Cox回归模型分析影响预后的因素。结果:同步放化疗组和新-术-放疗组5年无进展生存率分别为80.8%、74.6%,总生存分别为85.6%、81.8%,两组间5年无进展生存率及总生存差异均无统计学意义(分别为P=0.43和P=0.62)。同步放化疗组随访期间6例患者(12.24%)出现死亡,新-术-放疗组7例(16.67%)患者死亡,两组之间差异无统计学意义(P=0.55)。同步放化疗组2例(4.08%)患者出现复发和(或)转移,新-术-放疗组4例(9.52%)出现复发和(或)转移,两组之间差异无统计学意义(P=0.42)。Ⅲ-Ⅳ级近期毒副反应同步放化疗组出现3例(6.12%),新-术-放疗组出现2例(4.76%),两组之间差异无统计学意义(P=1);远期毒副反应中,无Ⅲ级及以上的慢性放射性反应发生,同步放化疗组4例(8.16%)患者出现放射性肠炎,新-术-放疗组同样4例(9.52%)患者出现放射性肠炎,另外2例(4.76%)患者出现下肢水肿,两组之间差异无统计学意义(P=0.50)。Cox回归比例风险模型分析肿瘤直径大于4 cm是无进展生存期和总生存期的预后不良因素(P均<0.05)。结论:同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGOⅡ_b 期宫颈癌的复发转移率、无进展生存期及总生存期无统计学意义(P>0.05)。同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGOⅡ_b 期宫颈癌的近期及远期毒性反应无统计学意义(P>0.05)。
Objective： To compare treatment outcome and adverse effects for Federation of Gynecology and Obstetrics（ FIGO） stage Ⅱ_b cervical carcinoma patients received radical radiotherapy with concurrent chemotherapy versus neoadjuvant chemotherapy combined with radical surgery followed by adjuvant postoperative radiotherapy,including recurrence and metastasis rate,progression-free survival（ PFS）,overall survival（ OS）,adverse reactions,and prognostic factors. Methods： Retrospectively reviewed the medical records of FIGO stage Ⅱ_b cervical cancer patients who were treated from September 2008 to December 2013. A total of the data of 49 patients underwent radical radiotherapy with concurrent chemotherapy（ CCRT group）. These patients were compared with 42 patients that received neoadjuvant chemotherapy combined with Radical hysterectomy with adjuvant radiotherapy（ NACT-surgery-based group）.The recurrence and metastasis rate,progression-free survival（ PFS）,overall survival（ OS）,and treatment-related complications were compared between the two groups. Using SPSS 19. 0 statistical software,Chi-square test or Student＇s t test was applied in comparing variables between groups; the Kaplan-Meier survival analysis,Log-rank test to compare survival rates between the groups; using Cox proportional-hazards regression model for multivariate analysis. Results： Similar rates of 5-year PFS 80. 8 % vs 74. 6%（ Log-rank,P = 0. 43） and 5-year OS 85. 6% vs81. 8%（ Log-rank,P = 0. 62） were observed for the CCRT group and the NACT-surgery-based group,respectively. 6 cases（ 12. 24%） and 7 cases（ 16. 67%） cases died between the CCRT group and the NACT-surgery-based group during follow-up,respectively,the difference between the two groups was no statistically significant（ P =0. 55）. 2（ 4. 08%） patients and 4 patients（ 9. 5 2 %） had recurrence and metastasis,no significant difference（ P= 0. 42） between the two groups. Moreover,the incidence of grade Ⅲ-Ⅳ acute reactions were no statistically significant between the two groups. Grade Ⅲ-Ⅳ late stage toxicity and chronic radiation cystitis were not observed. 4 patients with chronic radiation intestinal injury in the CCRT group as well as the NACT-surgery-based group,and2（ 4. 76%） patients occurred lower limb edema in the NACT-surgery-based group. The difference between the two groups was no statistically significant（ P = 0. 50） for late stage toxicity. Cox multivariate analyses found no significant difference in survival outcome between the two groups,and tumor diameter was identified as significant prognostic factors for PFS and OS（ P〈 0. 05）. Conclusion： Recurrence and metastasis rate,progression-free and overall survival between the CCRT group and NACT-surgery-based group were no significant difference（ P〉 0. 05）. The acute and late stage toxicity of concurrent between two group for FIGO Ⅱ_b cervical cancer was no significant difference（ P 〉0. 05）.
出处
《现代肿瘤医学》
CAS
2017年第15期2467-2471,共5页
Journal of Modern Oncology
关键词
宫颈癌
Ⅱb期
手术
同步放化疗
毒副反应
cevical carcinoma
stage Ⅱb
concurrent chemotherapy
surgery
adverse effects
