中晚期子宫颈鳞癌患者同步放化疗的疗效及远处转移的影响因素分析  

Outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy

作　　者：马瑞兰[1] 张海琛[1] 邹丽娟[1] 曲怡[1] 

机构地区：[1]大连医科大学附属第二医院肿瘤放疗科,116023

出　　处：《中华妇产科杂志》2015年第2期125-130,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨中晚期（Ⅱb～Ⅳa期）子宫颈鳞癌同步放化疗的疗效及远处转移的影响因素。方法收集2006年1月至2010年12月于大连医科大学附属第二医院接受同步放化疗的118例中晚期子宫颈鳞癌患者的临床病理资料,患者的中位年龄为48岁（23～70岁）；临床分期：按国际妇产科联盟（FIGO）2009年的分期标准，Ⅱb期56例，Ⅲa期6例，Ⅲb期52例，Ⅳa期4例；肿瘤直径：〉4 cm者55例，≤4 cm者63例；盆腔淋巴结转移：有转移者为35例，无转移者83例；治疗前血红蛋白（Hb）水平：≤110 g/L者为40例，〉110 g/L者为78例；治疗前血清鳞状细胞癌抗原（SCC-Ag）水平：〉1.5μg/L者91例，≤1.5μg/L者27例；治疗后SCC-Ag水平：〉1.5μg/L者34例，≤1.5μg/L者84例。回顾性分析子宫颈鳞癌患者同步放化疗后的疗效及副反应，并对影响同步放化疗后远处转移的因素进行分析。结果（1）118例患者中，复发37例，复发率为31.4%（37/118）；其中局部复发者13例，远处转移者19例，局部复发和远处转移均有者5例。患者的5年总生存率为64.0%，5年无远处转移生存率为78.8%。急性副反应：2例发生Ⅲ级胃肠道反应（主要为腹泻），20例发生Ⅲ～Ⅳ度骨髓抑制；晚期放疗反应：5例发生Ⅲ～Ⅳ级胃肠道反应，2例发生Ⅲ或Ⅳ级膀胱反应。（2）单因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后血清SCC-Ag水平、治疗前Hb水平、盆腔淋巴结转移明显相关（P〈0.05）；多因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后SCC-Ag水平、盆腔淋巴结转移明显相关（P〈0.05）。结论中晚期子宫颈鳞癌患者同步放化疗的疗效满意，且安全性好。同步放化疗后远处转移的影响因素包括临床分期、治疗后血清SCC-Ag水平和盆腔淋巴结转移，对这些患者需要考虑新�Objective To evaluate the outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy （CCRT）. Methods A total of 118 patients with International Federation of Gynecology and Obstetrics （FIGO, 2009 version） stageⅡb-Ⅳa cervical squamous cell carcinoma treated with CCRT between 2006 and 2010 in the Second Affiliated Hospital of Dalian Medical University were analyzed. Their median age was 48 years （range, 23-70 years）. FIGO stages were as follows：Ⅱb stage 56 cases,Ⅲa stage 6 cases,Ⅲb stage 52 cases, andⅣa stage 4 cases. Of the all patients, 55 cases showed bulkly tumor （tumor size〉4 cm） and 35 cases were pelvic lymph node positive. Forty patients had pretreatment hemoglobin （Hb） levels no greater than 110 g/L. Patients with elevated squamous cell carcinoma antigen （SCC-Ag） 〉1.5 μg/L before CCRT and at one month after CCRT were 91 cases and 34 cases, respectively. Kaplan-Meier method was used to estimate survival. For the analysis of prognostic factors affecting distant metastasis, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis. Results Thirty-seven patients were diagnosed with recurrence, 19 cases of whom developed distant metastasis, 13 cases developed loco-regional recurrence and 5 cases had both distant and loco-regional recurrence. The＆amp;nbsp;5-year overall survival rates and distant disease-free survival of all patients were 64.0% and 78.8%, respectively. Two patients had grade 3 acute gastrointestinal toxicity （mainly diarrhea） and 20 cases had grade 3 to 4 hematologic toxicity. Seven patients experienced grade 3 to 4 late toxicity, 5 cases of them were gastrointestinal and 2 cases were genitourinary toxicity. Univariate analysis showed that FIGO stages, SCC-Ag level at one month after treatment, pretreatment hemoglobin level, and pelvic lymph node metastasis were significantly correlated with dist

关 键 词：宫颈肿瘤 癌 鳞状细胞 化放疗 淋巴转移 肿瘤分期 抗原 肿瘤 

分 类 号：R737.33[医药卫生—肿瘤]