不同放疗方案对宫颈癌根治术后复发伴转移患者的近远期疗效及预后影响因素分析
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摘要
目的探讨不同放疗方案对宫颈癌根治术后复发伴转移患者的近远期疗效,并分析其预后影响因素。方法对2013年3月—2015年6月96例宫颈癌根治术后复发伴转移患者的临床资料进行回顾性分析,并根据放疗方案的不同将患者分为观察组和对照组,每组48例。对照组给予后程调强放疗加量方案,观察组给予同期调强放疗加量方案。比较2组的近期、远期疗效及毒副反应发生情况,并通过Cox回归分析患者的预后危险因素。结果治疗后,观察组的近期总有效率、疾病控制率、中位总生存期和3年生存率均高于对照组(P<0.05)。观察组脊髓抑制发生率低于对照组(P<0.05)。有脉管瘤栓、肿瘤直径>4 cm、切缘阳性、淋巴结转移数目>3个是影响宫颈癌根治术后复发伴转移患者预后的独立危险因素(P<0.05)。结论应用同期调强放疗加量方案治疗可提高宫颈癌根治术后复发伴转移患者的近期疗效,延长生存时间,治疗过程中应注意上述影响患者预后的独立危险因素。
Objective To investigate short-term and long-term efficacy of different radiotherapy regimens in treatment of patients having recurrence and metastasis after radical operation for cervical cancer, and to analyze influencing factors of prognosis. Methods Clinical data of 96 patients having recurrence and metastasis after radical operation for cervical cancer admitted during March 2013 and June 2015 was retrospectively analyzed and the patients were divided into observation group and control group(n=48 in each group) according to different radiotherapy schemes. Control group was given posterior integrated boost intensity-modulated radiation therapy, while observation group was given simultaneous integrated boost intensity-modulated radiation therapy. In two groups, short-term and long-term efficacy and incidence rate of toxic and side effects were compared, and prognostic risk factors were analyzed by Cox regression. Results After treatment, in observation group, values of short-term total effective rate, disease control rate, median total survival time and 3-year survival rate were significantly higher than those in control group(P<0.05); incidence rate of spinal cord inhibition was significantly lower than that in control group(P<0.05). Vascular tumor embolus, tumor diameter more than 4 cm, positive margin of incision and number of lymph node metastases more than 3 were independent risk factors affecting prognosis of patients having recurrence and metastasis after radical operation for cervical cancer(P<0.05). Conclusion Simultaneous integrated boost intensity-modulated radiation therapy may improve short-term efficacy and prolong survival time of patients having recurrence and metastasis after radical operation for cervical cancer. During the course of treatment, independent risk factors affecting prognosis should be paid attention.
Objective To investigate short-term and long-term efficacy of different radiotherapy regimens in treatment of patients having recurrence and metastasis after radical operation for cervical cancer, and to analyze influencing factors of prognosis. Methods Clinical data of 96 patients having recurrence and metastasis after radical operation for cervical cancer admitted during March 2013 and June 2015 was retrospectively analyzed and the patients were divided into observation group and control group(n=48 in each group) according to different radiotherapy schemes. Control group was given posterior integrated boost intensity-modulated radiation therapy, while observation group was given simultaneous integrated boost intensity-modulated radiation therapy. In two groups, short-term and long-term efficacy and incidence rate of toxic and side effects were compared, and prognostic risk factors were analyzed by Cox regression. Results After treatment, in observation group, values of short-term total effective rate, disease control rate, median total survival time and 3-year survival rate were significantly higher than those in control group(P<0.05); incidence rate of spinal cord inhibition was significantly lower than that in control group(P<0.05). Vascular tumor embolus, tumor diameter more than 4 cm, positive margin of incision and number of lymph node metastases more than 3 were independent risk factors affecting prognosis of patients having recurrence and metastasis after radical operation for cervical cancer(P<0.05). Conclusion Simultaneous integrated boost intensity-modulated radiation therapy may improve short-term efficacy and prolong survival time of patients having recurrence and metastasis after radical operation for cervical cancer. During the course of treatment, independent risk factors affecting prognosis should be paid attention.
引文
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[16] 陈晓梅,陈世洪,王越希,等.宫颈癌ⅡB期术前同期放化疗联合根治术与根治性放疗同期化疗疗效对比[J].武警后勤学院学报:医学版,2017,26(3):208-211.
[17] 彭俊,黄勇.90例年轻宫颈癌患者临床特征及术后复发和预后相关因素分析[J].实用妇产科杂志,2016,32(1):42-45.
[18] 覃小敏,李琳,黄艳丽,等.中老年宫颈癌患者预后相关影响因素的分析[J].癌症进展,2015,13(3):346-349.
[19] 陆婕,吴晓杰,朱巍立.根治性宫颈癌手术患者盆腔淋巴结转移和预后的影响因素分析[J].中华全科医学,2017,15(2):270-273.
[20] 孙春堂,谭燕,谭本旭,等.宫颈癌盆腹腔转移淋巴结同步加量与后程加量放疗的临床效果比较[J].实用妇产科杂志,2016,32(7):532-536.
[21] 马晓雯.宫颈癌156例术后复发及预后相关因素分析[D].石家庄:河北医科大学,2014.
[22] 胡香梅,邓娅莉.子宫颈癌伴盆腔淋巴结转移临床分析[J].中华保健医学杂志,2012,14(3):239-240.
[23] 祝莉,曲丽霞,权丽丽.宫颈癌盆腔淋巴结转移的临床特征及影响因素分析[J].癌症进展,2017,15(9):1079-1081.
[2] 吴明梅,魏坤,李正清.不同放疗方案辅助治疗中晚期宫颈癌合并盆腔淋巴结转移对比观察[J].检验医学与临床,2018,15(5):705-708.
[3] 李小凡,李永恒,苏星.宫颈癌初始治疗后腹主动脉旁淋巴结转移调强放疗的临床观察[J].中华放射医学与防护杂志,2015,35(7):522-527.
[4] 张霞,王赟,俞青苗,等.调强放疗对宫颈癌术后伴中危因素患者生存质量的影响[J].中华全科医学,2017,15(12):2045-2047,2144.
[5] 孙凌飞,温翠侠,刘凌.子宫颈癌根治术后同步与序贯放化疗的临床研究[J].现代中西医结合杂志,2016,25(36):4071-4072.
[6] 刘秀兰,宝莹娜.同步放化疗联合伽马刀治疗伴盆腔淋巴结转移宫颈癌的临床研究[J].中国肿瘤临床,2015,42(2):96-99.
[7] 张楠,郑虹,高雨农,等.伴有淋巴结转移的ⅠB1～ⅡA2期宫颈癌两种治疗方式的回顾性研究[J].实用妇产科杂志,2017,33(9):707-710.
[8] 朱茜,刘岿然,邓新.血清鳞状细胞癌抗原和癌胚抗原及癌抗原125联合检测在宫颈癌诊断中的临床意义[J].中国综合临床,2013,29(6):646-648.
[9] Lee J H,Kang S H,Kim Y,et al.Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy:a retrospective study[J].Korean J Anesthesiol,2016,69(2):126-132.
[10] 底学敏,王泽阳,任红,等.125I粒子植入治疗宫颈癌放疗后复发腹膜后淋巴结转移10例[J].介入放射学杂志,2017,26(2):137-141.
[11] 胡翔,周云,刘凌.宫颈癌根治术后体外盆腔放疗联合阴道腔内放疗临床观察[J].山东医药,2015,55(7):85-86.
[12] 李晓娟,史颖,崔晓萍.不同调强放疗方案联合化疗同步治疗中晚期宫颈癌临床研究[J].解放军医药杂志,2017,29(11):14-17.
[13] 陈锡山,邹文,杜祯,等.同步放化疗与新辅助化疗联合手术加辅助放疗治疗Ⅱb期宫颈癌的对比分析[J].现代肿瘤医学,2017,25(15):2467-2471.
[14] 王骁,徐晓婷,李莉,等.不同放化疗方案治疗宫颈癌患者的临床疗效[J].肿瘤,2015,35(6):653-659.
[15] 刘明博,王兰芹,李白羽,等.宫颈癌根治术后三维适形放疗与调强放疗治疗效果比较[J].中华实用诊断与治疗杂志,2018,32(1):84-86.
[16] 陈晓梅,陈世洪,王越希,等.宫颈癌ⅡB期术前同期放化疗联合根治术与根治性放疗同期化疗疗效对比[J].武警后勤学院学报:医学版,2017,26(3):208-211.
[17] 彭俊,黄勇.90例年轻宫颈癌患者临床特征及术后复发和预后相关因素分析[J].实用妇产科杂志,2016,32(1):42-45.
[18] 覃小敏,李琳,黄艳丽,等.中老年宫颈癌患者预后相关影响因素的分析[J].癌症进展,2015,13(3):346-349.
[19] 陆婕,吴晓杰,朱巍立.根治性宫颈癌手术患者盆腔淋巴结转移和预后的影响因素分析[J].中华全科医学,2017,15(2):270-273.
[20] 孙春堂,谭燕,谭本旭,等.宫颈癌盆腹腔转移淋巴结同步加量与后程加量放疗的临床效果比较[J].实用妇产科杂志,2016,32(7):532-536.
[21] 马晓雯.宫颈癌156例术后复发及预后相关因素分析[D].石家庄:河北医科大学,2014.
[22] 胡香梅,邓娅莉.子宫颈癌伴盆腔淋巴结转移临床分析[J].中华保健医学杂志,2012,14(3):239-240.
[23] 祝莉,曲丽霞,权丽丽.宫颈癌盆腔淋巴结转移的临床特征及影响因素分析[J].癌症进展,2017,15(9):1079-1081.