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  

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

作　　者：王宁[1] 魏丽春[1] 石梅[1] 刘隽悦[1] 李围围[1] 李剑平[1] 张莹[1] 李侠 黄艳红 

机构地区：[1]西安,第四军医大学西京医院肿瘤放疗科,西安710032 [2]病理科 [3]妇产科

出　　处：《中华放射肿瘤学杂志》2012年第5期448-451,共4页Chinese Journal of Radiation Oncology

摘　　要：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ⅠB2～ⅢB期宫颈癌患者资料，其中59例RT，123例术前每周顺铂40mg／m＾2同期RT，放疗剂量40～50Gy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≥4．5cm时术前CRCT与RT的3年无进展生存（PFS）、总生存（OS）率均相似（X＾2=1．84、1．56，P=0．176、0．221），＜4．5cm时术前CRCT比RT的PFS、OS率高直径（＜6em与≥6cm）是PFS、OS的影响因素（X^2=2．56、4．06，P=0．011、0．007），年龄（＜48岁与≥48岁）是OS的影响因素（X＾2=4．86，P=0．046），术后淋巴结状况（是否转移）是PFS的影响因素（X＾2=1．04，P＝0．010）。结论术前CRCT联合根治性子宫切除术可获较好生存率，原发病灶大小、年龄、术后淋巴结状况为重要预后因素。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 Ⅰ82-ⅢBcervical carcinoma were treated with preoperative CRCT （123 patients） or RT alone （59 patients） followed by radical surgery. Weekly cisplatin （40 mg/mz） 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 （ X^2 = 1.84 and 1.56, P = 0. 176 and 0. 221 ）. For patients with tumor 〈4. 5 em, CRCT group had higher PFS and OS rates than RT alone （ X^2 = 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 （ t〉6 cm vs. 〈 6 cm） was significant prognostic factor for PFS and OS （X^2 = 2. 56, P = 0. 011 ; X^2 = 4. 06, P = 0. 007 ）, age （〈48 vs. ≥48 years ） was significant prognostic factor for OS （X^2= 4. 86, P = 0. 046 ）, and postoperative lymph node status （positive vs. negative） was significant prognostic factor for PFS （ X^2 = 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 ⅠB2-ⅢB cervical cancer. Tumor diameter, age and postoperative lymph node status are important prognostic factors for survival.

关 键 词：宫颈肿瘤/外科学 宫颈肿瘤/放射疗法 宫颈肿瘤/化学疗法 预后 

分 类 号：R737.33[医药卫生—肿瘤]