不同辅助治疗方法对Ⅰb～Ⅱa期子宫颈癌术后有危险因素患者预后的影响  

Results of different postoperative adjuvant therapies for stage I b - II a cervical carcinoma with risk factors

作　　者：温宏武[1] 黄卫平[2] 刘桐宇[3] 马珂[1] 陶霞[1] 朱丽荣[1] 廖秦平[1] 

机构地区：[1]北京大学第一医院妇产科,100034 [2]石家庄市第五医院妇产科 [3]福建省肿瘤医院妇科

出　　处：《中华妇产科杂志》2013年第12期920-924,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨不同的辅助治疗方法对Ⅰb～Ⅱa期子宫颈癌术后有危险因素患者预后的影响。方法白1995年3月至2010年6月，在北京大学第一医院妇产科行手术治疗，且术后有危险因素并进一步行辅助化疗（化疗组，79例）、放疗或放化疗联合治疗（放化疗组，58例）的Ⅰb～Ⅱa期子宫颈癌患者共137例，两组患者均行子宫广泛性切除＋盆腔淋巴结切除术。术后危险因素分为中危冈素（包括肿瘤直径〉4cm、脉管癌栓、浸润问质深层）和高危因素（包括宫旁转移、淋巴结转移和切缘阳性）。同颐性分析两组患者的临床病理特征；用Kaplan—Meier法计算并比较两组患者的5年生存率；对影响患者预后的因素进行分析，单因素分析采用log—rank检验，多因素分析采用Cox逐步回归法。结果化疗组与放化疗组患者的年龄、新辅助化疗、临床分期、病理类型、病理分化程度、肿瘤直径、问质浸润深度、宫旁转移分别比较，差异均无统计学意义（P〉0．05）；而两组患者的术后危险因素程度、脉管癌栓、淋巴结转移分别比较，差异则有统计学意义（P〈0．05）。化疗组、放化疗组患者的5年生存率分别为88．6％、89．7％，两组比较，差异无统计学意义（P=0．455）。单因素分析显示，病理类型、术后危险因素程度、高危因素个数、宫旁转移、淋巴结转移与患者的预后有关（P〈0．05）；多因素分析最示，临床分期、病理类型、术后危险因素程度是影响患者预后的独立因素（P〈0．05）。进一步对术后具有不同程度危险因素的子宫颈癌患者分别给予不同方式的辅助治疗后的预后进行分析，结果显示，在43例有术后高危因素的患者中，给予化疗、放化疗患者（分别为18、25例）的5年生存率分别为77．8％、80．0％，3年无瘤生存率分别为100．0％、80．0％，分别比较，差异均无统�Objective To investigate the effects of postoperative adjuvant chemotherapy （CT） and chemoradiotherapy （CRT） or radiotherapy（RT） for I b- I[ a cervical cancer with risk faetors. Methods From March 1995 to June 2010, there were 137 patients underwent radical hysterectomy and systematic pelvic lymphadenectomy for stage I b - 11 a cervical cancer admitted at Peking University First Hospital. These patients had risk factors, intermediate risk factors including bulky tumor （ 〉4 cm） , lymph vascular space invasion, deep stromal invasion; high risk factors including positive surgical margin, parametrial invasion, lymph node involvement. Of the all patients, 79 cases of them were treated with CT,58 of them were treated with RT or CRT. The 5-year survival and prognosis factors were analyzed retrospectively, the prognosis was compared between two adjuvant therapy groups. Results The univariate analysis shown that types of pathology, different grade of risk factors, stroma invasion and lymph node involvement were prognostic factors of 5-year overall survival. Patients with squamous cell carcinoma, intermediate risk factors, no parametrial invasion, and no lymph node involvement had better prognosis （P 〈 0.05 ）. Whether patients with high-risk factors or intermediate-risk factors, the 5-year overall survival and 3-year disease-free survival had no difference between CT and RCT or RT groups respectively. Cox regression multivariate analysis of survival indicated that clinical stages, types of histology, different grade of risk factors were independent prognostic indicator. Patients with early stage, squamous cell carcinoma, intermediate risk factors had better prognosis. Univariate and multivariate analysis indicated that different postoperative adjuvant therapies had no effects on the prognosis. The 5-year overall survival was 88.6% in patients treated with CT, and 89. 7% in patients treated with RT or CRT （P = 0. 455 ）. Conclusion There are equivalent therapeutic results between CT and RT or CRT

关 键 词：宫颈肿瘤 化学疗法 辅助 放射疗法 预后 

分 类 号：R737.33[医药卫生—肿瘤]