MR联合血清SSCA检测对宫颈癌患者疗效及预后预测分析  

Evaluation of MR combined with detection of serum squamous cell carcinoma antigen on the outcomes and prognisis of cervical cancer

作　　者：王燕[1] 舒月红[1] 丁叔波 胡伟[1] 何慧娟[1] WANG Yan;SHU Yue-hong;DING Shu-bo;HU Wei;HE Hui-juan(Department of Radiotherapy,People's Hospital of Quzhou ,Quzhou 324000,P.R.China)

机构地区：[1]衢州市人民医院肿瘤放疗科

出　　处：《中华肿瘤防治杂志》2018年第21期1522-1527,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的在宫颈癌同步放化疗(concurrent radiochemotherapy,CRT)过程中MR可以发现实体肿瘤大小的影像学改变,鳞状细胞癌相关抗原(squamous cell carcinoma antigen,SSCA)血清学水平可近似评估患者放化疗后肿瘤负荷。本研究旨在明确MR检查联合SSCA血清水平检测的早期治疗应答能否评估局部晚期宫颈癌患者的生存预后。方法回顾性分析2011-01-01-2014-12-31在衢州市人民医院肿瘤放疗科接受CRT序贯腔内放疗的187例宫颈癌患者放化疗前后MR图像,评估放化疗前后肿瘤FIGO分期。收集包括1年内肿瘤复发率和无复发生存时间、腹主动脉旁淋巴结复发率和局部复发率、3年内癌症死亡率和生存时间等数据。所有患者接受外照射的治疗剂量中位数为48.6Gy,同期给予4个周期顺铂化疗。根据治疗前后FIGO分期及SCCA变化水平将患者分为早期应答阳性组(56例)和阴性组(100例)。采用χ^2检验比较两组的死亡率和复发率,Kaplan-Meier法描绘生存曲线,Log-rank检验比较两组间生存曲线差异,Cox多因素回归模型分析影响生存期的独立危险因素。结果早期应答阳性组1年内死亡率(10.7%)和阴性组(21.0%)比较,差异无统计学意义,χ^2=0.429,P=0.512,但阳性组3年内癌症死亡率、1年内局部复发率和腹主动脉旁淋巴结转移复发率(25.0%、12.5%和8.9%)低于阴性组(59.0%、47.0%和39.0%),χ^2=6.721、11.314和7.184,均P<0.05。Log-rank分析提示阳性组1年内无肿瘤复发中位生存期、3年内中位生存期[(11.91±0.05)个月和(32.84±1.05)个月]长于阴性组[(10.9±0.20)个月和(29.16±0.85)个月],χ^2=4.65、4.98,均P<0.05,但两组间1年内无癌症死亡生存期差异无统计学意义,χ^2=0.78,P=0.475。经Cox多因素风险比例回归模型校正后,初始FIGO分期(HR=5.228,95%CI:2.605~10.491)和早期治疗学应答(HR=0.419,95%CI:0.209~0.843)为影响1年内肿瘤复发事件风险的独立危险因素。结论早期治疗应答是局部晚期宫�OBJECTIVE The concurrent radiochemotherapy(CRT)followed by brachytherapy is a standard treatment for local advanced cervical cancer.During CRT,marked change of tumor size is often observed in magnetic resonance imaging(MRI).The serum levels of squamous cell carcinoma antigen(SSCA)have been used for the assessment of therapeutic response after cancer therapy.The primary aim of this study was to assess whether the therapeutic response reflected by serum levels of SSCA combination with MRI imaging according to FIGO classification could effectively predict clinical outcomes.METHODS The MR imaging data of 187 patients who received CRT treatment in People’s Hospital of Quzhou with cervical cancer before and after therapy from January 1st,2011 to December 31st,2014 were retrospectively reviewed.The initial and post-treatment FIGO classification of the patients were assessed and the information about clinical outcomes were collected during follow-up.A median dose 48.6 Gy of external beam radiation and 4 cycles of weekly cisplatin were given simultaneously.Patients were divided into early therapeutic responsive group(56 cases)and early therapeutic non-responsive group(100 cases)according to FIGO staging and SCCA level before and after treatment.The difference in 3-year cancer related death rate,1-year cancer related death rate and 1-year recurrence rate in any regions between the two groups were assessed by Chi-square test.Kaplan-Meier analysis and log-rank test were performed to depict and analyze the difference of 1-year survival,3-year survival and 1-year survival without progression.Cox proportional hazard ratio model was used to evaluate the independent risk factors associated with the 1-year cancer recurrence.RESULTS There was no statistic difference between early therapeutic responsive group(10.7%)and non-responsive group(21.0%)in 1-year cancer related death rate(χ^2=0.429,P=0.512).The mortality rate of cancer within 3 years,local recurrence rate within 1 year and recurrence rate of para-aortic lymph node metast

关 键 词：宫颈癌 同步放化疗 客观治疗学应答 MR成像 鳞状细胞癌相关抗原 

分 类 号：R737.33[医药卫生—肿瘤]