182例局部晚期宫颈癌根治性子宫切除术加术前新辅助治疗预后分析

目的 观察局部晚期宫颈癌根治性子宫切除术加术前同期放化疗(CRCT)、单纯放疗(RT)的疗效,并分析影响预后的因素。方法 回顾分析2006—2011年收治的 182例Ⅰ_B2~Ⅲ_B期宫颈癌患者资料,其中 59例RT,123例术前每周顺铂40 mg/m²同期RT,放疗剂量 40~50 Gy分 20~25次。新辅助治疗后 2~3周行全子宫、双附件及盆腔淋巴结切除术。采用Cox法行多因素预后分析。结果 随访时间满 3年者为 69例。肿瘤直径≥4.5 cm时术前CRCT与RT的 3年无进展生存(PFS)、总生存(OS)率均相似(χ²=1.84、1.56,P=0.176、0.221),<4.5 cm时术前CRCT比RT的PFS、OS率高(χ²=5.22、4.81,P=0.022、0.018)。全组 3年PFS、OS率分别为92.0%、93.8%。Cox分析显示肿瘤直径(<6 cm与≥6 cm)是PFS、OS的影响因素(χ²=2.56、4.06,P=0.011、0.007),年龄(<48岁与≥48岁)是OS的影响因素(χ²=4.86,P=0.046),术后淋巴结状况(是否转移)是PFS的影响因素(χ²=1.04,P=0.010)。

Clinical results and prognostic factors of patients with locally advanced cervical carcinoma treatedwith neoadjuvant therapy followed by radical hysterectomy:a retrospective study of 182 patients

Objective To analyze the clinical outcome and prognostic factors of concurrent radiochemotherapy (CRCT) or radiotherapy (RT) alone followed by radical hysterectomy in cervical cancer. Methods Between April 2006 and June 2011, 182 patients with FIGO Ⅰ_B2-Ⅲ_B cervical carcinoma were treated with preoperative CRCT (123 patients) or RT alone (59 patients) followed by radical surgery. Weekly cisplatin (40 mg/m²) were administered during radiotherapy for patients treated with CRCT. Preoperative RT doses were 40－50 Gy in 20－25 fractions. Total hysterosalpingo-oophorectomy and pelvic lymph node dissection was performed 2－3 weeks after neoadjuvant therapy. The prognostic factors were analyzed by Cox-regression method. Results Sixty-nine patients were followed up for 3 years. For patients with tumor ≥4.5 cm, there were no significant differences in the 3-year progression-free survival (PFS) and overall survival (OS) rates between CRCT and RT alone (χ²=1.84 and 1.56, P=0.176 and 0.221). For patients with tumor<4.5 cm, CRCT group had higher PFS and OS rates than RT alone (χ²=5.22 and 4.81,P=0.022 and 0.018). The 3-year PFS and OS rates were 92.0% and 93.8%. By multivariate analysis, tumor diameter (≥6 cm vs.<6 cm) was significant prognostic factor for PFS and OS (χ²=2.56,P=0.011;χ²=4.06,P=0.007), age (<48 vs. ≥48 years) was significant prognostic factor for OS (χ²=4.86,P=0.046), and postoperative lymph node status (positive vs. negative) was significant prognostic factor for PFS (χ²=1.04,P=0.010). Conclusions Treatment with CRCT or RT followed by radical surgery has achieved good OS and PFS for patients with FIGO Ⅰ_B2-Ⅲ_B cervical cancer. Tumor diameter, age and postoperative lymph node status are important prognostic factors for survival.