宫颈癌根治性放疗期间肿瘤退缩率对患者预后的影响

目的 探讨宫颈癌根治性放疗期间肿瘤退缩率（tumor regression rate, TRR）对患者预后的影响。方法选择接受根治性放疗±同期顺铂化疗的初诊ⅠB1-ⅣA期宫颈癌患者。外照射开始后第4~5周行三维后装放疗。基线及第1次后装放疗前均行盆腔磁共振（MRI）检查，肿瘤大小采用盆腔MRI三维肿瘤最大单径表示。TRR=（基线肿瘤大小-后装前肿瘤大小）/基线肿瘤大小×100%, TRR≥75%与TRR<75%分组进行比较。结果共分析107例患者，中位随访时间27.6个月（3.0~59.0个月）。鳞癌94.4%， FIGO ⅢA~ⅣA期72.0%，同期化疗患者比例85.0%。基线及后装前肿瘤大小分别为(5.0±1.8)cm，(2.4±1.7)cm；TRR为（51.3±34.0）%。TRR≥75%患者的2年局部控制率（LCR）（100% vs 80.9%，P=0.018）及2年总生存率（OS）（96.0% vs 77.6%，P=0.012）均高于TRR<75%的患者。COX分析显示TRR（P=0.005, HR=0.972, 95% CI 0.953~0.991）及基线肿瘤大小（P=0.007, HR=1.460, 95% CI 1.109~1.922）与LCR相关;TRR(P=0.031, HR=0.981, 95% CI 0.964~0.998)及基线肿瘤大小(P=0.027, HR=1.416, 95% CI 1.041~1.926)与OS相关。基线血小板/淋巴细胞比值（PLR）及放疗后体重减轻百分比与TRR≥75%相关。结论宫颈癌根治性放疗期间的TRR与肿瘤的LCR及OS相关，第4~5周时TRR<75%的患者具有更高的局部失败和死亡风险。

Prognostic implications of tumor regression rate during radical radiotherapy in patients with cervical cancer

Objective To study the prognostic effects of tumor regression rate (TRR) during radical (chemo)radiotherapy for cervical cancer. Methods Patients with FIGO IB1-IVA cervical cancer from January 2015 through September 2019 were retrospectively analyzed. All patients were treated with radical (chemo)radiotherapy and had available baseline and pre-brachytherapy (BT) pelvic MRI. Brachytherapy was first performed at 4 to 5-week from the start of radiotherapy. Tumor size was defined as the largest single diameter measured three-dimensionally on MRI. TRR = (baseline tumor size-pre-BT tumor size)/baseline tumor size ×100%. Results A total of 107 patients were eligible. Median follow-up was 27.6 months (range 3.0~59.0). Squamous cell carcinoma accounted for 94.4%. FIGO (2018) ⅢA-ⅣA accounted for 72.0%. Eighty-five percent patients received concurrent chemotherapy. Baseline and pre-BT tumor sizes were (5.0±1.8) cm and (2.4±1.7) cm, respectively. TRR was (51.3±34.0)%. Compared with TRR<75%, patients with TRR≥75% had significantly higher 2-year local control rate (LCR) (100% vs. 80.9%, P=0.018) and 2-year overall survival (OS) rate (96.0% vs. 77.6%, P=0.012). COX analysis showed that TRR (P=0.005, HR=0.972, 95%CI: 0.953-0.991) and baseline tumor size (P=0.007, HR=1.460, 95%CI: 1.109-1.922) were associated with LCR; TRR (P=0.031, HR=0.981, 95%CI: 0.964-0.998) and baseline tumor size (P=0.027, HR=1.416, 95%CI: 1.041-1.926) were associated with OS. Baseline platelet-to-lymphocyte ratio (PLR) and the percentage of weight loss after radiotherapy were correlated with TRR≥75%. Conclusion The TRR during radical (chemo)radiotherapy for cervical cancer is correlated to LCR and OS. Patients with TRR <75% at the 4th to 5th week have higher risks of local failure and death.