同步放化疗治疗Ib2和IIa2期宫颈癌疗效及预后相关因素分析

目的:探讨同步放化疗治疗Ib2期和IIa2期宫颈癌的疗效和不良反应,并分析预后影响因素。方法:回顾分析2000年1月至2010年12月首都医科大学附属北京妇产医院妇瘤科收治的73例接受同步放化疗的Ib2和IIa2期宫颈癌患者的临床病理资料。统计有效率和疾病控制率评价近期疗效,统计3年、5年无瘤生存率(DFS)及总生存率(OS)评价远期疗效,记录患者的不良反应,并分析可能影响患者预后的相关因素。结果:同步放化疗治疗Ib2期和IIa2期宫颈癌的有效率(CR+PR)为91.78%,疾病控制率(CR+PR+SD)为97.26%;3年DFS为84.93%,0S为86.30%;5年DFS为79.45%,0S为82.19%。所有不良反应患者均可耐受,对症治疗后均可缓解。单因素分析显示,患者的生存率与肿瘤的病理类型、分化程度、大小、有无淋巴结转移以及治疗前后血鳞状细胞癌抗原(SCC-Ag)值有关(P0.05)。多因素分析表明,肿瘤病理类型、大小、有无淋巴结转移及治疗后1个月血SCC-Ag值为远期疗效的独立影响因素。结论:同步放化疗治疗Ib2期和IIa2期宫颈癌的近、远期疗效肯定,不良反应可耐受,是一种可供选择的方法。病理类型为腺癌、肿瘤直径﹥5cm、有淋巴结转移、治疗后1个月血SCC-Ag值≥1.5ng/ml者预后较差,需进一步加强研究。

Analysis of efficacy and prognostic factors of concurrent chemoradiotherapy in patients with stage Ib2 and IIa2 cervical cancer

Objective:To investigate the efficacy and side effects of concurrent chemoradiotherapy in the treatment of stage Ib2 and IIa2 cervical cancer,and to analyze the prognostic factors.Methods:The clinicopathologic data of patients with stage Ib2 and IIa2 cervical cancer who received concurrent chemoradiotherapy from Jan.2000 to Dec.2010 in our hospital,were analyzed retrospectively.The overall response rate and disease control rates were used to evaluate the short-term outcomes.The 3-year,and 5-year disease-free survival (DFS) and overall survival (OS) were used to evaluate the long-term efficacy.The toxicity reactions were recorded,and the relevant prognostic factors were discussed.Results:The overall response rate (CR+PR) and disease control rate (CR+PR+SD) of concurrent chemoradiotherapy in patients with stage Ib2 and IIa2 cervical cancer were 91.78%,97.26 %,respectively.The 3-year DFS was 84.93%,the 3-year OS was 86.30%.The 5-year DFS was 79.45% and the 5-year OS was 82.19%.All side effects can be tolerated and can be alleviated by symptomatic treatment.The univariate analysis showed that tumor pathological type,differentiated degree,size of primary tumor,lymph node metastasis and squamous cell carcinoma antigen (SCC-Ag) levels before and after treatment were closely related to the survival (P<0.05).Further multivariate analysis showed that tumor pathological type,size of primary tumor,lymph node metastasis and SCC-Ag levels after treatment 1 month were the independent prognostic factors for long-term outcome.Conclusions:The short term and long term efficacy of concurrent chemoradiotherapy in the treatment of stage Ib2 and IIa2 cervical cancer is clear and definite.The toxic side effects can be tolerated.So it is an alternative method.In this part of the patients,adenocarcinoma,tumor diameter﹥5cm,with lymph node metastasis and SCC-Ag levels ≥1.5ng/mL after treatment 1 month with poor prognosis,further study should be strengthened in these patients.