术后放疗在子宫肉瘤治疗中的意义

目的 探讨子宫肉瘤术后放疗的价值和预后因素。方法 回顾分析本院1994—2014年收治的经病理确诊的182例子宫肉瘤患者资料。49例术后放疗,133例未术后放疗。放疗采用盆腔野体外照射,处方剂量30~50 Gy分10~25次,5 次/周。采用Kaplan-Meier法计算LRRFS、OS并Logrank法检验差异,Cox法多因素预后分析。结果 全组5年样本量为114例,术后放疗、未放疗的分别为24、90例(分别为2008年10月前收治的例数)。全组5年LRRFS、OS分别为62.1%、56.2%,术后放疗、未放疗的LRRFS分别为78.0%、55.3%(P=0.013),OS分别为64.1%、51.7%(P=0.070)。多因素分析显示病理类型、组织学分级、分期是LRRFS及OS影响因素(P=0.032、0.008、0.000及P=0.046、0.000、0.000),术后放疗是LRRFS的影响因素(P=0.013)。结论 术后放疗显著提高子宫平滑肌肉瘤LRRFS和OS,为子宫平滑肌肉瘤术后个体化放疗提供证据,但仍需进一步探讨。

The significance of postoperative radiotherapy in uterine sarcoma

Objective To evaluated the role of postoperative radiotherapy (PR) after surgery in patients with uterine sarcoma,and analyzed the prognostic factors.Methods A total of 182 patients with uterine sarcoma were included between June 1994 and October 2014.Radiotherapy dose were 30-50 Gy/10-25 fractions/5 fractions/week.The LRFFS and OS were calculated with Kaplan-Meier method,and difference was analyzed with log-rank method.Cox regression analyses were used to determine prognosticators.Results There were 114 patients which survived more than 5-years in this whole group,including PR 24 cases and no PR 90 cases.The 5-year LRRFS and OS were 62.1％ and 56.2％,respectively.The 5-year LRRFS were 78.0％ and 55.3％ on PR and no PR (P=0.013);with OS 64.1％ and 51.7％ on PR and no PR (P=0.070).A multivariate analysis showed that pathological types,histological grade and clinical stage were associated with LRRFS and OS (P=0.032,0.008,0.000 and 0.046,0.000,0.000).PR was significant influencing factor for OS (P=0.013).Conclusions Uterine sarcoma patients treated with PR after surgery had an improved LRRFS compared to those treated with surgery,especially those with leiomyosarcoma.The role of PR personalized radiation for uterine sarcoma still needs to be further discussed.