488例FIGO 2018 Ⅲc期子宫颈鳞癌患者的治疗及预后分析  

Treatment and prognosis analysis of 488 patients with FIGO 2018 stage Ⅲc squamous cervical cancer

作　　者：冯涛 寿华锋 袁淑慧[1] 唐华容[1] 吕晓娟[1] 殷卓敏[1] 楼寒梅[1] 倪镌[1] Feng Tao;Shou Huafeng;Yuan Shuhui;Tang Huarong;Lyu Xiaojuan;Yin Zhuomin;Lou Hanmei;Ni Juan(Department of Gynecologic Tumor Radiotherapy,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine,Chinese Academy of Sciences,Hangzhou 310022,China;Department of Gynecology,Zhejiang People Hospital,Hangzhou 310014,China)

机构地区：[1]浙江省肿瘤医院妇瘤放疗科、中国科学院杭州医学研究所,杭州310022 [2]浙江省人民医院妇科,杭州310014

出　　处：《中华妇产科杂志》2023年第5期359-367,共9页Chinese Journal of Obstetrics and Gynecology

基　　金：浙江省医药卫生科技计划(2020KY056)。

摘　　要：目的分析国际妇产科联盟2018年(FIGO 2018)分期Ⅲc期子宫颈鳞癌患者的治疗及预后。方法收集2013年5月至2015年5月浙江省肿瘤医院收治的临床病理资料及随访资料完整的488例子宫颈鳞癌患者进行回顾性分析, 患者年龄为(57.9±11.3)岁。根据治疗方式的不同分为手术组(子宫颈癌根治性手术联合术后辅助放化疗, 324例)和放疗组(子宫颈癌根治性放疗±同步化疗, 164例), 比较两组患者的临床特点、预后及并发症发生率。随访截至2022年5月, 随访时间为(96±12)个月(范围:84~108个月)。结果 (1)临床特点:手术组患者的初始治疗时美国东部肿瘤协作组(ECOG)评分、肿瘤最大径≥4 cm的比例、FIGO 2018分期(包括Ⅲc1期和Ⅲc2期)、治疗时间、治疗费用分别与放疗组比较, 差异均有统计学意义(P均<0.01)。(2)预后:①不同期别的Ⅲc期子宫颈鳞癌患者(488例):对于439例Ⅲc1期患者, 手术组、放疗组患者的7年生存率分别为83.6%、52.9%, 两组比较, 差异有统计学意义(P<0.001);对于49例Ⅲc2期患者, 手术组、放疗组患者的7年生存率分别为48.0%、33.3%, 两组比较, 差异无统计学意义(P=0.296)。②肿瘤最大径≥4 cm的患者(278例):对于246例Ⅲc1期患者, 手术组、放疗组患者的7年生存率分别为81.2%、51.9%, 两组比较, 差异有统计学意义(P<0.001);分层分析显示, 手术组(299例)Ⅲc1期患者中肿瘤最大径≥4 cm比例为46.2%(138/299), 放疗组(140例)为77.1%(108/140), 两组比较, 差异有统计学意义(P<0.001);进一步分层分析, 将放疗组中原FIGO 2009分期为Ⅱb期的肿瘤最大径≥4 cm的患者提取出来, 共有46例, 其7年生存率为67.4%, 与手术组(为81.2%)比较, 差异无统计学意义(P=0.052)。对于32例Ⅲc2期患者中, 手术组、放疗组患者的7年生存率分别为50.0%、37.5%, 两组比较, 差异无统计学意义(P=0.157)。③髂总淋巴结有转移的患者(126例):手术组、放疗组患者的Objective To analyze the treatment and prognosis of patients with International Federation of Gynecology and Obstetrics(FIGO)2018 stageⅢc cervical squamous cell carcinoma.Methods A total of 488 patients at Zhejiang Cancer Hospital between May,2013 to May,2015 were enrolled.The clinical characteristics and prognosis were compared according to the treatment mode(surgery combined with postoperative chemoradiotherapy vs radical concurrent chemoradiotherapy).The median follow-up time was(96±12)months(range time from 84 to 108 months).Results(1)The data were divided into surgery combined with chemoradiotherapy group(surgery group)and concurrent chemoradiotherapy group(radiotherapy group),including 324 cases in the surgery group and 164 cases in the radiotherapy group.There were significant differences in Eastern Cooperation Oncology Group(ECOG)score,FIGO 2018 stage,large tumors(≥4 cm),total treatment time and total treatment cost between the two groups(all P<0.01).(2)Prognosis:①for stageⅢc1 patients,there were 299 patients in the surgery group with 250 patients survived(83.6%).In the radiotherapy group,74 patients survived(52.9%).The difference of survival rates between the two groups was statistically significant(P<0.001).For stageⅢc2 patients,there were 25 patients in surgery group with 12 patients survived(48.0%).In the radiotherapy group,there were 24 cases,8 cases survived,the survival rate was 33.3%.There was no significant difference between the two groups(P=0.296).②For patients with large tumors(≥4 cm)in the surgery group,there were 138 patients in theⅢc1 group with 112 patients survived(81.2%);in the radiotherapy group,there were 108 cases with 56 cases survived(51.9%).The difference between the two groups was statistically significant(P<0.001).Large tumors accounted for 46.2%(138/299)vs 77.1%(108/140)in the surgery group and radiotherapy group.The difference between the two groups was statistically significant(P<0.001).Further stratified analysis,a total of 46 patients with large tumors of FI

关 键 词：宫颈肿瘤 癌 鳞状细胞 肿瘤分期 抗肿瘤联合化疗方案 预后 

分 类 号：R737.33[医药卫生—肿瘤]