A nomogram predicting the risks of distant metastasis following postoperative radiotherapy for uterine cervical carcinoma: A Korean radiation oncology group study (KROG 12-08)

Purpose

To develop a nomogram predicting the risks of distant metastasis following postoperative adjuvant radiation therapy for early stage cervical cancer.

Materials and methods

We reviewed the medical records of 1069 patients from ten participating institutions. Patients were divided into two cohorts: a training set (n = 748) and a validation set (n = 321). The demographic, clinical, and pathological variables were included in the univariate Cox proportional hazards analysis. Clinically established and statistically significant prognostic variables were utilized to develop a nomogram.

Results

The model was constructed using four variables: histologic type, pelvic lymph node involvement, depth of stromal invasion, and parametrial invasion. This model demonstrated good calibration and discrimination, with an internally validated concordance index of 0.71 and an externally validated c-index of 0.65. Compared to FIGO staging, which showed a broad range in terms of distant metastasis, the developed nomogram can accurately predict individualized risks based on individual risk factors.

Conclusions

The devised model offers a significantly accurate level of prediction and discrimination. In clinical practice it could be useful for counseling patients and selecting the patient group who could benefit from more intensive/further chemotherapy, once validated in a prospective patient cohort.     

60例原发灶不明的颈转移性鳞癌的放射治疗

目的：探讨颈淋巴结的临床分期和不同大小的放射治疗野对原发灶不明的颈转移性鳞癌的预后影响。方法：回顾性分析本院1989年1月至1997年12月间收治的60例原发灶不明的预转移性鳞癌（不包括锁骨上区转移者）的临床资料。结果：全组病例5年总的生存率为68．5％,其中N1,N2和N3病例的5年生存率分别为100％,68．0％和40．9％（χ^2=0.729,P=0.026),而单侧颈部,全颈部和扩大野照射者的5年生存率分别为66．5％,74．5％和54．6％（χ^2=1.38,P=0.501),Cox比例风险模型分析发现颈淋巴结分期对生存率的影响有显著性意义（P＝0．032）,5年颈部局部控制率为65．6％,其中N1,N2和N3病例的5年局部控制率分别为100％,63．2％和34．6（χ^2=5.51,P=0.064),而单侧颈部,全颈部和扩大野照射者的5年局部控制率分别为87．6％、51．0％和72．7％（χ^2=2.55,P=0.279）,5年原发病灶的出现率为21．2％,小野（单侧颈部或全颈部照射）和扩大野照射的5年原发灶出现率分别为23．3％和12．5％（χ^2=0.52,P=0.469),结论：颈淋巴结的临床分期是影响生存率的重要预后因素,并且随着期别的升高,颈部局控率有下降的趋势;小野较扩大野照射的原发灶出现率有增加的趋势,但不同大小照射野治疗的颈部局部治疗率和生存率无明显差异。     

益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎疗效观察

目的:探讨益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎临床疗效。方法:研究对象选取我院2015年7月至2017年7月收治宫颈癌放疗后放射性肠炎患者共100例,以随机数字表法分为对照组（50例）和中西医组（50例）,分别给予西药单用和在此基础上加用益肠促愈方辅助治疗,比较两组综合疗效,内镜疗效,治疗前后主要证候评分、日常生活质量评分、转化生长因子β1（transforming growth factor β1,TGF-β1）水平及药物毒副反应发生率。结果:中西医组综合疗效和内镜疗效均显著优于对照组（P<0.05）;中西医组治疗后主要证候评分显著低于对照组、治疗前（P<0.05）;中西医组治疗后EORTC QOL-C30量表评分均显著高于对照组、治疗前（P<0.05）;中西医组治疗后TGF-β1水平显著低于对照组、治疗前（P<0.05）;同时两组药物毒副反应发生率比较差异无统计学意义（P>0.05）。结论:益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎可有效减轻消化道和全身症状,促进肠黏膜损伤修复,调节TGF-β1水平。