宫颈癌根治性放疗后复发转移的模式与预后  

Pattern and prognosis of recurrence and metastasis of cervical cancer after radical chemoradiotherapy

作　　者：毋楚樊 冯涛 徐青 饶慧婷 吕晓娟[2] 楼寒梅[2] Wu Chufan;Feng Tao;Xu Qing;Rao Huiting;Lyu Xiaojuan;Lou Hanmei(Zhejiang University of Chinese Medicine,Hangzhou 310053,China;Department of Gynecological Radiation Therapy,Zhejiang Cancer Hospital,Hangzhou Institute of Medical Sciences,Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]浙江中医药大学,杭州310053 [2]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

出　　处：《中华放射肿瘤学杂志》2024年第3期231-236,共6页Chinese Journal of Radiation Oncology

基　　金：浙江省医药卫生重大科技计划重点项目(WKJ-ZJ-2020)。

摘　　要：目的探索宫颈癌根治性放疗后的复发模式以及预后特点。方法回顾性分析2011年8月—2017年12月在浙江省肿瘤医院接受根治性放疗的1359例Ⅰ-ⅣA期(按国际妇产科协会2009分期)的患者资料并随访,对资料详实的249例复发转移患者进行生存及预后因素分析。主要观察终点为复发/转移后生存期。采用Kaplan-Meier法计算生存率,log-rank检验进行单因素分析,Cox模型进行多因素分析。结果249例患者的远处转移率为77.5%,局部复发率为36.9%。按照转移复发部位及其与放疗野的关系进行分组,单纯放疗野内复发(A组)56例,单纯放疗野外转移(B组)157例,其中仅野外淋巴结转移(B1组)56例,仅野外血行转移(B2组)78例,野外淋巴结与血行同时转移(B3组)23例,放疗野内野外联合复发/转移(C组)36例。A组、B1组、B2组、B3组、C组中位生存时间分别为13、24、13、11、9个月(P<0.001)。按照初诊至复发/转移的间隔时间分组,≤1年组110例、>1~2年组74例、>2年组65例,三组患者的中位生存时间分别为11、14、22个月(P<0.001)。按照复发转移的后续治疗方式分组,姑息治疗138例,局部治疗15例,全身药物治疗45例,联合治疗51例,四组的中位生存时间分别为9、37、20、32个月(P<0.001)。多因素分析结果显示,年龄、复发/转移部位、再治疗方式、初治与复发时间间隔是影响患者生存的独立预后因素(均为P<0.05)。结论根治性放疗后的治疗失败模式以远处转移为主。放疗野外转移者,尤其是单纯淋巴结转移者,预后较好。综合治疗模式、初诊至复发间隔时间也是重要的预后因素。Objective To explore the recurrence pattern and prognosis of cervical cancer after radical chemoradiotherapy.Methods Clinical and follow-up data of 1359 patients with stageⅠ-ⅣA(International Federation of Gynecology and Obstetrics 2009 staging)who received radical radiotherapy in Zhejiang Cancer Hospital from August 2011 to December 2017 were retrospectively analyzed.The survival and prognostic factors of 249 patients with recurrence/metastasis with detailed data were analyzed.The primary endpoint was post-recurrence/metastasis survival time.Kaplan-Meier method was used to calculate the survival rate,log-rank test was used for single factor analysis,and Cox model was used for multi-factor analysis.Results The distant metastasis rate of 249 patients was 77.5%,and the local recurrence rate was 36.9%.According to the location of metastasis and recurrence,56 cases with recurrence in the field of radiotherapy alone were assigned into group A,157 cases with recurrence outside the radiation field alone were allocated into group B(56 cases with lymph node recurrence in group B1,78 cases with blood metastasis in group B2,and 23 cases with lymph node and blood metastasis simultaneously in group B3),and 36 cases with combined recurrence and metastasis in and out of the field of radiotherapy were assigned into group C.The median survival time of patients in groups A,B1,B2,B3 and C was 13,24,13,11 and 9 months,respectively(all P<0.001).According to the interval from initial diagnosis to recurrence/metastasis,110 cases were classified in≤1 year group,74 cases in>1-2 years group,and 65 cases in>2 years group.The median survival time of patients in the three groups was 11,14,and 22 months,respectively(all P<0.001).According to the management of recurrence/metastasis,138 cases received palliative treatment,15 cases received local treatment,45 cases received systemic treatment,and 51 cases received combined treatment.The median survival time of patients among four groups was 9,37,20 and 32 months,respectively(all P<0.001).Th

关 键 词：宫颈肿瘤 局部晚期 放射疗法 根治性 预后 肿瘤复发 肿瘤转移 

分 类 号：R737.33[医药卫生—肿瘤]