106例局部晚期宫颈癌根治性同步放化疗的临床疗效及预后影响因素  

Analysis of clinical efficacy and prognostic factors of radical simultaneous radiotherapy and chemotherapy in 106 patients with locally advanced cervical cancer

作　　者：陈宝杰 杜丹 邓宇 周业琴[1,2] 李贤富 Chen Baojie;Du Dan;Deng Yu(Department of Oncology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000)

机构地区：[1]川北医学院附属医院肿瘤科,南充637000 [2]医学影像四川省重点实验室,四川省肿瘤学重点学科,南充637000

出　　处：《现代妇产科进展》2023年第3期207-213,共7页Progress in Obstetrics and Gynecology

基　　金：四川卫生计生委项目(No:19PJ037);医学影像四川省重点实验室开放课题项目(No:MIKLSP202107);川北医学院附属医院科研项目(No:2022ZD004)。

摘　　要：目的:分析无髂总淋巴结和腹主动脉旁淋巴结转移局部晚期宫颈癌患者根治性同步放化疗临床疗效、放疗毒性反应,探讨预后影响因素。方法:回顾分析2018年1月至2020年8月川北医学院附属医院肿瘤科放疗中心行根治性同步放化疗的106例局部晚期宫颈癌患者的临床资料,其中43例采用常规全盆腔放疗(PRT),63例采用盆腔延伸野放疗(EFRT)。通过实体瘤疗效评价标准评估近期疗效,用总生存期(OS)、无进展生存期(PFS)评估远期疗效。通过单因素和多因素分析影响预后的因素。依据肿瘤放射治疗协作组放射损伤分级标准评估放疗毒性反应。结果:106例患者客观缓解率为77.4%,疾病控制率为93.4%。1、3年OS率分别为95.2%、78.5%,1、3年PFS率分别为85.1%、68.1%。多因素分析显示,PRT是局部晚期宫颈癌患者OS(HR=3.78,95%CI为1.21~11.87,P=0.023)和PFS(HR=3.13,95%CI为1.302~8.428,P=0.012)的独立危险因素;盆腔淋巴结转移数目(<3枚和≥3枚)、近期疗效是影响OS的独立预后因素(P<0.05)。年龄、近期疗效是影响PFS的独立预后因素(P<0.05)。无患者出现大于3级的急性胃肠道毒性,3例(2.8%)患者出现3~4级慢性胃肠道毒性。24例(22.6%)患者出现3~4级骨髓抑制。结论:CT、MRI或PET-CT显示无髂总和腹主动脉旁淋巴结转移局部晚期宫颈癌根治性同步放化疗近、远期疗效确切。EFRT能改善局部晚期宫颈癌患者OS和PFS。通过盆腔淋巴结转移数目(<3枚和≥3枚)、近期疗效(CR/PR/SD/PD)可预测预后。PRT、EFRT放疗毒性可接受。Objective:The clinical efficacy and radiotherapy toxicity of radical concurrent chemoradiotherapy in patients with locally advanced cervical cancer without iliac and para-aortic lymph node metastasis were analyzed,and the prognostic factors were discussed.Methods:The clinical data of 106 patients with locally advanced cervical cancer were reviewed,including 43 patients with conventional total pelvic radiotherapy(PRT)and 63 patients with pelvic extended-field radiotherapy(EFRT).Response evaluation criteria in solid tumors evaluated the short-term effect,and the long-term impact was assessed by overall survival(OS)and progression-free survival(PFS).The prognostic factors were analyzed by univariate and multivariate analysis.The radiation toxicity was evaluated according to the Toxicity criteria of the Radiation Therapy Oncology Group.Results:The objective response rate of 106 patients was 77.4%,and the disease control rate was 93.4%.The 1-year and 3-year OS rates were 95.2%and 78.5%,respectively.The 1-year and 3-year PFS rates were 85.1%and 68.1%,respectively.Multivariate analysis showed that PRT was an independent risk factor for OS(HR=3.78,95%CI 1.21~11.87,P=0.023)and PFS(HR=3.13,95%CI 1.302~8.428,P=0.012)in patients with locally advanced cervical cancer,and the number of pelvic lymph node metastasis(<3 and≥3)and short-term efficacy were independent prognostic factors for OS.Age and short-term efficacy were independent factors affecting the prognosis of PFS.No patient had acute gastrointestinal toxicity greater than grade 3,and 3 patients(2.8%)had grade 3~4 chronic gastrointestinal toxicity.Twenty-four patients(22.6%)had grade 3~4 myelosuppression.Conclusion:CT,MRI,or PET-CT show that radical concurrent chemoradiotherapy is effective in patients with locally advanced cervical cancer without common iliac and para-aortic lymph node metastasis.EFRT can improve OS and PFS in patients with locally advanced cervical cancer.The prognosis can be predicted by the number of pelvic lymph node metastasis(<3 and≥3)and sho

关 键 词：宫颈癌 延伸野放疗 盆腔放疗 同步放化疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]