预防照射腹主动脉旁淋巴引流区对高危子宫内膜癌患者疗效的前瞻性研究  

Prospective Randomized Study of Prophylactic Para-aortic Field Irradiation in Patients with High-risk Endometrial Cancer

作　　者：章玲玲 刘雅雯 涂海燕[1] 李凌[1] 李金高[2] ZHANG Lingling;LIU Yawen;TU Haiyan(Jiangxi Maternal and Child Health Hospital,Nanchang,330006)

机构地区：[1]江西省妇幼保健院,330006 [2]江西省肿瘤医院,330029

出　　处：《实用癌症杂志》2021年第8期1364-1367,共4页The Practical Journal of Cancer

基　　金：江西省卫健委课题项目(编号:20185404)

摘　　要：目的探讨高危子宫内膜癌术后病理学及影像学上无腹主动脉旁淋巴结肿大的患者,予以腹主动脉旁淋巴引流区预防性照射的疗效及安全性分析。方法经确诊并行手术后病理存在高危因素的Ⅰb~Ⅲc1期子宫内膜癌患者82例,随机分为两组,其中预防照射组采用延伸野照射即予盆腔外照射+腹主动脉旁淋巴引流区预防照射,对照组为单纯盆腔外照射。分析两组患者的生存及不良反应。结果预放照射组(EF-IMRT)和盆腔照射组(P-IMRT)两组3年0S比较无统计学差异(100%vs.97.6%,P=0.348);EF-IMRT组3年DFS明显高于P-IMRT组(97.3%vs.85.7%,P=0.049)。P-IMRT组出现远处转移5例,EF-IMRT组发生局部复发1例,两组远处转移率有统计学差异(11.9%vs.0.00%,P=0.024),EF-IMRT组远处转移率显著低于P-IMRT组。EF-IMRT组与P-IMRT组的3级以上胃肠道急性不良反应发生率、骨髓抑制的发生率及泌尿系统急性不良反应发生率分别为17.5%vs.11.9%(P=0.474)、12.5%vs.9.5%(P=0.666)、2.5%vs.4.7%(P=0.586),均无统计学差异。Cox回归因素分析显示:特殊病理类型、盆腔淋巴结转移、术后病理分期晚是影响高危子宫内膜癌预后的重要危险因素。结论对于术后高危子宫内膜癌患者,给予腹主动脉旁淋巴引流区预防照射,可降低远处转移率,提高DFS,但未改善总生存率,不良反应可耐受,或可成为临床治疗的选择。Objective To investigate the efficacy and safety of prophylactic irradiation of para-aortic lymphatic area in high-risk endometrial cancer patients without para-aortic lymphadenopathy.Methods 82 patients with stage IB-IIIC1 endometrial cancer diagnosed and with high risk factors for postoperative pathology were enrolled.40 cases randomly assigned to the prophylactic irradiation group treated as the extended-field intensity-modulated radiation group(EF-IMRT group)and 42 cases were chosen simultaneously as the pelvic intensity-modulated radiation group(P-IMRT group).The survival and adverse reactions of patients of the 2 groups were analyzed.Results There was no statistically significant difference between EF-IMRT group and P-IMRT group in terms of 3-year 0 S(100%vs.97.6%,P=0.348);The 3-year DFS of EF-IMRT group was significantly higher than that of P-IMRT group(97.3%vs.85.7%,P=0.049).There were 5 cases of distant metastasis in the P-IMRT group and 1 case of local recurrence in the EF-IMRT group,and there was a statistically significant difference in the rate of distant metastasis between the 2 groups(11.9%vs.0.00,P=0.024),the distant metastasis rate of EF-IMRT group was significantly lower than that of P-IMRT group.The incidence of grade 3 or above acute adverse reactions in gastrointestinal tract,myelosuppression and urinary tract were 17.5%vs.11.9%(P=0.474),12.5%vs.9.5%(P=0.666)and 2.5%vs.4.7%(P=0.586)in EF-IMRT group and P-IMRT group,respectively,and there was no statistical difference.Cox regression analysis showed that specific pathological types,pelvic lymph node metastasis and pathological stage were important risk factors affecting the prognosis of high-risk endometrial cancer.Conclusion For patients with high risk endometrial cancer after surgery,prophylactic irradiation of para-aortic lymphatic region can reduce the rate of distant metastasis and improve disease-free survival,but does not improve the overall survival.Adverse reactions can be tolerated,which may be the choice of clinical treatment.

关 键 词：腹主动脉旁淋巴结 高危子宫内膜癌 预防照射 生存 不良反应 

分 类 号：R737.33[医药卫生—肿瘤]