子宫颈癌调强放射治疗的预后分析  

Prognosis in patients treated with intensity modulated radiotherapy for cervical cancer

作　　者：李向阳[1] 谢小妹[1] 刘凌[1] 殷海涛[1] 卜祥兆[1] 孙凌飞[1] 管峦[1] 陈猛[1] LI Xiang-yang XIE Xiao-mei LIU Ling YIN Hai-tao BU Xiang-zhao SUN Ling-fei GUAN Luan CHEN Meng(Department of Radiotherapy, Xuzhou Central Hospital, Xuzhou 221006, China)

机构地区：[1]江苏省徐州市中心医院放射治疗科,徐州221006

出　　处：《中国肿瘤临床与康复》2017年第5期563-566,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨子宫颈癌调强放射治疗的疗效以及影响预后的因素。方法选取2011年1月至2012年12月间徐州市中心医院收治的78例术后行调强放射治疗的子宫颈癌患者,收集患者临床病理资料和预后资料,采用免疫组化技术检测患者子宫颈活检组织中缺氧诱导因子(HIF-1α)、血清鳞状细胞癌抗原(SCC)水平及血红蛋白(Hb)水平。结果 78例患者4年无瘤生存率为74.4%,4年总生存率为76.9%。其中15例复发,13例复发后死亡,2例带瘤存活。复发者中6例局部复发,6例远处转移,3例局部复发+远处转移。HIF-1α阳性表达率为60.3%,阳性细胞主要集中位于子宫颈癌中央区,肿瘤浸润前沿分布散在,且中央区呈现强阳性表达。阳性表达与血清放射治疗前血红蛋白水平、放射治疗后SCC-Ag水平及宫旁浸润和肿瘤直径均有明显相关性,差异有统计学意义(P<0.05)。多因素分析显示,淋巴结转移、宫旁浸润、治疗后1个月SCC-Ag值≥1.5mg/L、HIF-1阳性表达和放射治疗前血红蛋白<120g/L是影响总生存时间的主要因素,差异均有统计学意义(均P<0.05)。结论淋巴结转移、宫旁浸润、治疗后1个月SCC-Ag值≥1.5 mg/L、HIF-1阳性表达、放射治疗前血红蛋白<120g/L是影响子早期子宫颈癌根治性放射治疗患者总生存时间的主要因素。Objective To investigate the efficacy and prognostic factors of intensity modulated ra- diotherapy （IMRT） for cervical cancer. Methods Select 78 patients who were treated with IMRT for cervi- cal cancer at Xuzhou Central Hospital from January 2011 to December 2012. Patients＇ clinical pathological and prognostic data were collected. Immunohistochemical technique was used to detect the levels of hypoxia inducible factor-1 （ HIF-1 ）, serum squamous cell carcinoma antigen （ SCC ） and hemoglobin （Hb）. Results The 4-year disease-free survival rate was 74.4% and 4-year overall survival rate was 76.9%. Among them, 15 patients had recurrence, 13 patients died and 2 patients survived. Among patients with re- currence, 6 patients had local recurrence, 6 patients had distant metastasis and 3 patients had local recur- rence and distant metastasis. The positive expression rate of HIF-1 was 60. 3%. The positive cells mainly located in the central area of uterine cervical carcinoma. Tumor invasion front scattered in the central, which showed strong positive expression. The positive expression was significantly correlated with serum he- moglobin level before radiotherapy, SCC-Ag level after radiotherapy, parametrial infiltration and tumor di- ameter （P 〉 0. 05）. Multivariate analysis showed that lymph node metastasis, parametrial infiltration, SCC- Ag≥1.5 mg/L at 1 month after treatment, positive expression of HIF-1 and hemoglobin 〈 120g/L before ra- diotherapy were the main factors influencing the overall survival time （ all P 〉 0. 05 ）. Conclusion Lymph node metastasis, parametrial invasion, SCC-Ag ≥ 1.5 mg/L at 1 month after treatment, the positive expres- sion of HIF-1 before radiotherapy and the hemoglobin 〈 120g/L before radiotherapy are the main factors in-fluencing the overall survival time in patients receiving radical radiation therapy for cervical cancer.

关 键 词：宫颈肿瘤 调强放射疗法 HIF-1Α 血清鳞状细胞癌抗原 

分 类 号：R730.55[医药卫生—肿瘤] R737.33[医药卫生—临床医学]