大菜花型宫颈癌的放疗效果及预后分析

目的 回顾性分析大菜花型宫颈癌的放疗效果及预后因素。方法 64例经病理证实的大菜花型宫颈癌,肿瘤最大直径5~8 cm(平均6.5cm),按FIGO新分期标准放疗前临床分期:IIA期9例,IIB期19例,IIIA期5例,IIIB期31例。采用外照射、肿瘤组织间插植及腔内照射综合手段进行根治性放疗。根据放疗第4周妇检记录进行“放疗中再分期”。采用Kaplan-Meier法计算生存率,并将年龄、病理类型与分化程度、肿瘤最大径、放疗前分期和“放疗中再分期”等因素纳入Cox模型进行预后的多因素分析。结果 放疗中再分期结果:I期9例,IIA期28例,IIB期13例,IIIA期5例,IIIB期9例。全组累计5年生存率和无瘤生存率分别为81%和75.8%。一系列因素中,只有“放疗中再分期”是影响生存率的重要和独立的预后因素(P<0.01)。结论 大菜花型宫颈癌根治性放疗效果较好;放疗前分期不准确,对估计预后无价值;“放疗中再分期”是影响预后的主要因素。

Radiotherapeutic effect and prognosis of bulky exophytic cervical cancer

Objective To retrospectively analyze the factors affecting the radiotherapeutic effects and prognosis of patients with bulky exophytic cervical camcer. Methods Sixty-four patients with bulky exophytic cervical camcer with a maximal diameter measuring 5 to 8 cm (mean 6.5 cm) were treated with a combined radiotherapy with external beam, interstitial, intracavitary irradiations. According to the FIGO staging system, 9 patients were classified as stage IIA, 19 as IIB, 5 as IIIA, and 31 as IIIB. The patients were restaged according to the same system based on the history records at the fourth week in the radiotherapy course. The cumulative survivals were analyzed with Kaplan-Meier method, and the factors influencing the prognosis including age, histology, maximal tumor diameter, stage before treatment and restage in radiotherapy were analyzed with Cox regression model. Results Restaging during radiotherapy classified 9 patients as stage I, 28 as IIA, 13 as IIB, 5 as IIIA, and 9 as IIIB. The 5-year overall survival rate was 81% and the 5-year relapse-free survival rate 75.8%. Multivariate Cox regression analyses identified the restage in radiotherapy as the only significant, independent prognostic factor for overall survival (P<0.01). Conclusions Radiotherapy can achieve satisfactory results for patients with bulky exophytic cervical cancer. The stage before treatment is inaccurate and not indicative of the prognosis, but the restage in radiotherapy can serve as a significant and independent prognostic factor.