Ⅲ期宫颈鳞癌同步放化疗与诱导化疗后同步放化疗的疗效及预后比较
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摘要
目的:探讨Ⅲ期宫颈鳞癌单纯同步放化疗与诱导化疗后同步放化疗的远期疗效及预后。方法:收集2006年2月10日至2012年10月20日湖北医药学院附属随州医院收治的247例Ⅲ期宫颈鳞癌患者的完整随访/病历资料。根据治疗方式不同,分为同步组和诱导组,对两组的疗效及预后进行对比分析。结果:所有患者平均中位随访时间5年,同步组与诱导组3年和5年总体生存率分别为82.0%和61.2%,83.3%和64.2%,两组间无统计学差异(P=0.630);单因素分析显示:肿块长径、淋巴结转移是影响生存的因素。COX多因素分析显示淋巴结转移是预后独立影响因素。两组患者局部复发率、病死率、远处转移率、近远期不良反应无统计学差异(P>0.05)。结论:Ⅲ期宫颈鳞癌患者同步放化疗与诱导化疗后同步放化疗疗效及不良反应发生率相当,淋巴结转移是影响生存期的独立影响因素。
Objective To investigate the long term efficacy and prognosis of stage Ⅲ cervical squamous cell carcinoma treated by concurrent chemoradiotherapy and concurrent chemoradiotherapy after induction chemotherapy.Methods Complete follow-up/medical records of 247 patients with stage III cervical squamous cell carcinoma admitted to Suizhou Hospital affiliated to Hubei Medical College from February 10,2006 to October 20,2012.According to different treatment methods,they were divided into synchronous group and induction group.The curative effect and prognosis of the two groups were compared and analyzed.Results The median follow-up time was 5 years for all patients.The 3 year and 5 year overall survival rates of the synchronous group and the induction group were 82.0% and 61.2%,83.3% and 64.2%,respectively.There was no statistical difference between the two groups(P = 0.630).Univariate analysis showed that the tumor size and lymph node metastasis were the factors affecting survival(P<0.05).COX multivariate analysis showed that lymph node metastasis was an independent prognostic factor.There was no significant difference in mortality,local recurrence,distant metastasis,short-term and long-term side effects between the two groups(P>0.05).Conclusion The efficacy and adverse reactions of concurrent chemoradiotherapy for stage III cervical squamous cell carcinoma was similar to that of induction chemoradiotherapy.Lymph node metastasis was an independent factor affecting survival.
Objective To investigate the long term efficacy and prognosis of stage Ⅲ cervical squamous cell carcinoma treated by concurrent chemoradiotherapy and concurrent chemoradiotherapy after induction chemotherapy.Methods Complete follow-up/medical records of 247 patients with stage III cervical squamous cell carcinoma admitted to Suizhou Hospital affiliated to Hubei Medical College from February 10,2006 to October 20,2012.According to different treatment methods,they were divided into synchronous group and induction group.The curative effect and prognosis of the two groups were compared and analyzed.Results The median follow-up time was 5 years for all patients.The 3 year and 5 year overall survival rates of the synchronous group and the induction group were 82.0% and 61.2%,83.3% and 64.2%,respectively.There was no statistical difference between the two groups(P = 0.630).Univariate analysis showed that the tumor size and lymph node metastasis were the factors affecting survival(P<0.05).COX multivariate analysis showed that lymph node metastasis was an independent prognostic factor.There was no significant difference in mortality,local recurrence,distant metastasis,short-term and long-term side effects between the two groups(P>0.05).Conclusion The efficacy and adverse reactions of concurrent chemoradiotherapy for stage III cervical squamous cell carcinoma was similar to that of induction chemoradiotherapy.Lymph node metastasis was an independent factor affecting survival.
引文
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[11]杜俊瑶,张新,李联昆.Ⅱb~Ⅲ期宫颈癌264例疗效及预后因素分析[J].中国实用妇科与产科杂志,2015,31(2):137-141.
[12] Einstein MH,Rash JK,Chappell RJ,et al. Quality of Life in cervical cancer survivors:Patient and provider perspectives on common complications of cervical cancer and treatment[J].Gynecol Oncol,2012,125(1):163-167.
[13] Tewari KS,Sill MW,Long IH,et al. Improved survival with bevacizumab in advanced cervical cancer[J]. N Engl J Med,2014,370(8):734-743.
[14] Tewari KS,Monk BJ.Development of a platform for systemic antiangiogenesis therapy for advanced cervical cancer[J].Clin Adv Hematol Oncol,2014,12(11):737-748.
[15] Yang XJ,Wang JY,Lin LM,et al.Concomitant chemoradiotherapy versus pure radiotherapy in locally advanced cervical cancer:a retrospective analysis of complications and clinical outcome[J]. Eur J Gynaecol Oncol,2016,37(4):499-503.
[16]唐滟,袁亚维.宫颈癌调强放射治疗同步化学药物治疗骨髓抑制的相关因素分析[J].中国现代医学杂志,2016,26(3):110-114.
[17] Nakano T,Kato S,Ohno T,et al.Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix[J]. Cancer,2005,103(1):92-101.
[2]曲思娆,武昕,赵晶,等.单纯放疗、新辅助化疗及同步放化疗治疗宫颈癌临床近期疗效比较[J].中国实用妇科与产科杂志,2010,26(12):943-945.
[3] Vale C,Tierney JF,Stewart LA,et al.Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer:a systematic review and Meta-Analysis of individual patient data from 18 randomized trials[J]. J Clin Oncol,2008,26(35):5 802-5 812.
[4]郑建清,黄碧芬,周云清,等.根治性同步放化疗+手术治疗局部晚期宫颈癌:一项随机对照试验的中期结果分析[J].中国循证医学杂志,2017,17(1):1-6.
[5]刘淑荣,廖革望.局部晚期宫颈癌化疗联合放疗最佳模式探讨[J].中华肿瘤防治杂志,2017,24(3):196-200.
[6] de Azevedo CR,Thuler LC,de Mello MJ,et al.Neoadjuvant chemotherapy followed by chemoradiation in cervical carcinoma:a review[J]. Int J Gynecol Cancer,2016,26(4):729-736.
[7] Symonds RP,Habeshaw T,Reed NS,et al.The Scottish and Manchester randomised trial of neo-adjuvant chemotherapy for advanced cervical cancer[J]. Eur J Cancer,2000,36(8):994-1 001.
[8] Randriamanovontsoa EN,Ratsimandresy DA,Rakotonarivo JM,et al.Result of concurrent chemoradiotherapy for cervical cancer at radiation oncology service of university hospital joseph ravoahangy andrianavalona from 2007 to 2009[J].Pan Afr Med J,2014(19):298.
[9] Morkhov KY,Nechushkina VM,Kuznetsov VV. Induction chemotherapy for locally advanced cervical cancer[J].Vopr Onkol,2015,61(2):208-213.
[10] Ke QH,Zhou SQ,Du W,et al.Early efficacy of taxotere and cisplatin Chemo-Radiotherapy for advanced cervical cancer[J].Asian Pac J Cancer Prev,2012,13(2):617-619.
[11]杜俊瑶,张新,李联昆.Ⅱb~Ⅲ期宫颈癌264例疗效及预后因素分析[J].中国实用妇科与产科杂志,2015,31(2):137-141.
[12] Einstein MH,Rash JK,Chappell RJ,et al. Quality of Life in cervical cancer survivors:Patient and provider perspectives on common complications of cervical cancer and treatment[J].Gynecol Oncol,2012,125(1):163-167.
[13] Tewari KS,Sill MW,Long IH,et al. Improved survival with bevacizumab in advanced cervical cancer[J]. N Engl J Med,2014,370(8):734-743.
[14] Tewari KS,Monk BJ.Development of a platform for systemic antiangiogenesis therapy for advanced cervical cancer[J].Clin Adv Hematol Oncol,2014,12(11):737-748.
[15] Yang XJ,Wang JY,Lin LM,et al.Concomitant chemoradiotherapy versus pure radiotherapy in locally advanced cervical cancer:a retrospective analysis of complications and clinical outcome[J]. Eur J Gynaecol Oncol,2016,37(4):499-503.
[16]唐滟,袁亚维.宫颈癌调强放射治疗同步化学药物治疗骨髓抑制的相关因素分析[J].中国现代医学杂志,2016,26(3):110-114.
[17] Nakano T,Kato S,Ohno T,et al.Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix[J]. Cancer,2005,103(1):92-101.
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