ⅢC期宫颈癌根治性放疗后预后相关因素分析  

Analysis of factors associated with the efficacy and prognosis of radical radiotherapy for stage IIIC cervical cancer

作　　者：张雯婷 修雨婷 王琢 王蕴龙 陈杰 孙宝胜[2] ZHANG Wenting;XIU Yuting;WANG Zhuo;WANG Yunlong;CHEN Jie;SUN Baosheng(Changchun University of Traditional Chinese Medicine,Changchun130117,China;Department of Radiotherapy,Tumor Hospital of Jilin Province,Changchun130012,China)

机构地区：[1]长春中医药大学,吉林长春130117 [2]吉林省肿瘤医院放疗科,吉林长春130012

出　　处：《中国实验诊断学》2024年第1期38-43,共6页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省科技发展计划项目(20210203096SF)。

摘　　要：目的探讨ⅢC期宫颈癌根治性放疗疗效及预后的影响因素分析。方法回顾性分析2017年1月—2021年1月于吉林省肿瘤医院放疗四科进行根治性放疗的宫颈癌ⅢC期患者的临床资料,ⅢC1r期患者98例,ⅢC2r期患者19例,观察近、远期疗效和相关预后因素。结果3年OS、DFS分别为75.2%、65.8%。单因素分析显示,总生存率与盆腔淋巴结转移部位、病理类型、分期明显相关;无病生存率则与盆腔淋巴结转移数量、分期有关(OS:χ^(2)=4.542、8.678、4.155;DFS:χ^(2)=5.975、9.047,P<0.05)。多因素分析显示病理类型是影响OS的独立预后因素(HR=0.280,P<0.05),DFS则受盆腔淋巴结转移数量和分期影响(HR=0.498、0.472,P均<0.05)。Logistics回归分析显示,影响ⅢC2r期腹主动脉旁淋巴结转移主要因素为同步放化疗周期数及髂总淋巴结转移(P<0.05)。结论腺癌、盆腔淋巴结转移数量≥3个及发生腹主动脉旁淋巴结转移的ⅢC期宫颈癌患者根治性放疗后的预后较差,需采取更加积极的治疗策略。同步放化疗周期数<4及髂总淋巴结转移的患者发生腹主动脉旁淋巴结转移的风险更大,需预防性扩大照射野范围。Objective To explore the analysis of factors influencing the efficacy and prognosis of radical radiotherapy for stage IIIC cervical cancer.Methods To retrospectively analyze the clinical data of cervical cancer patients with stage IIIC who underwent radical radiotherapy at the Department of RadiotherapyⅣof Jilin Cancer Hospital from January 2017to January 2021,of whom 98patients with stage IIIC1rand 19patients with stage IIIC2r.To observe the near-and long-term efficacy and related prognostic factors.Results The 3-year OS and DFS were 75.2%and 65.8%,respectively.Univariate analysis showed that OS was significantly associated with pelvic lymph node metastasis site,pathological type and stage;DFS was associated with the number and stage of pelvic lymph node metastasis(OS:χ^(2)=4.542,8.678,4.155;DFS:χ^(2)=5.975,9.047,P<0.05).Multifactorial analysis showed that the type of pathology was an independent prognostic factor affecting OS(HR=0.280,P<0.05),while DFS was influenced by the number and stage of pelvic lymph node metastases(HR=0.498,0.472,both P<0.05).logistic regression analysis showed that the main factors affecting stage IIIC2rabdominal para-aortic lymph node metastases were pelvic lymph nodes bilateral metastasis and metastasis to the commoniliac lymph nodes(P<0.05).Conclusion Patients with adenocarcinoma,≥3pelvic lymph node metastases and para-aorti lymph node metastases in stage IIIC cervical cancer have a poorer prognosis after radical radiotherapy,and more aggressive treatment strategies are needed.Patients with bilateral pelvic lymph node metastases and metastases to the commoniliac lymph nodes are at greater risk of developing metastases to the para-aortic lymph nodes and require prophylactic expansion of the irradiation field.

关 键 词：宫颈癌 淋巴结转移 根治性放疗 疗效 预后 

分 类 号：R737.33[医药卫生—肿瘤]