子宫颈腺鳞癌根治性放化疗与开腹手术肿瘤学结局对比研究  

A comparative study on oncological outcomes between radical chemoradiotherapy and primary laparotomic open surgery for cervical adenosquamous carcinoma

作　　者：王昱俨 刘萍[1] 彭程[1] 尹钊红 陈春林[1] 丁红梅 孙立新[3] 王莉[4] 李维丽[1] 郎景和 WANG Yu-yan;LIU Ping;PENG Cheng;YIN Zhao-hong;CHEN Chun-lin;DING Hong-mei;SUN Li-xin;WANG Li;LI Wei-li;LANG Jing-he(不详;Department of Obstertrics and Gynecology,Nan fang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]云浮市人民医院,广东云浮527300 [3]山西省肿瘤医院妇科,山西太原030001 [4]河南省肿瘤医院,河南郑州450008 [5]中国医学科学院、北京协和医学院、北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2024年第9期924-931,共8页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);广州市科技计划(158100075);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD019)。

摘　　要：目的 探讨根治性放化疗与开腹手术治疗子宫颈腺鳞癌的肿瘤学结局。方法 基于中国子宫颈癌临床诊疗项目大数据库筛选子宫颈腺鳞癌患者,以国际妇产科联盟(FIGO)2018分期作为分层依据,比较根治性放化疗与开腹手术患者肿瘤学结局。结果 (1)初始入组:根治性放化疗组97例,开腹手术组373例。根治性放化疗组5年总生存率(OS)与5年无病生存率(DFS)均差于开腹手术组(OS:69.2%vs. 83.7%,P<0.001;DFS:57.8%vs.81.3%,P<0.001)。Cox多因素分析显示根治性放化疗是影响患者肿瘤学结局的独立危险因素(OS:HR=2.094,95%CI 1.243~3.530,P=0.006;DFS:HR=2.477,95%CI 1.585~3.871,P<0.001)(2)ⅡB期及以内病例两组分别为36例和248例。两组5年OS与DFS差异无统计学意义(OS:89.9%vs. 88.3%,P=0.813;DFS:83.6%vs. 86.7%,P=0.510)。Cox多因素分析显示两组肿瘤学结局差异无统计学意义(OS:HR=0.731,95%CI 0.152~3.520,P=0.696;DFS:HR=0.726,95%CI 0.218~2.417,P=0.601)。(3)ⅢC期根治性放化疗组20例,开腹手术组100例。两组5年OS及DFS均提示开腹手术有着更优的肿瘤学结局(OS:44.6%vs. 65.9%,P=0.007;DFS:39.7%vs. 61.5%,P=0.012)。但Cox多因素分析显示两组肿瘤学结局差异无统计学意义(OS:HR=2.091,95%CI 0.936~4.672,P=0.072;DFS:HR=1.748,95%CI 0.827~3.692,P=0.143)。(4)Ⅲ~Ⅳ期根治性放化疗组48例,开腹手术组102例。两组5年OS差异无统计学意义,开腹手术组有更优的5年DFS(OS:58.7%vs. 66.9%,P=0.160;DFS:38.9%vs. 62.4%,P=0.012)。但Cox多因素分析显示,两组肿瘤学结局差异无统计学意义(OS:HR=2.126,95%CI 0.998~4.537,P=0.051;DFS:HR=1.855,95%CI 0.914~3.766,P=0.087)。结论 总体上子宫颈腺鳞癌患者根治性放化疗肿瘤学结局差于开腹手术;但经Cox多因素进一步分层分析,无论是ⅡB期以内患者还是ⅡB期以上期别的患者,两种治疗方式5年肿瘤学结局无显著性差异。Objective To investigate the oncological outcomes of radical chemoradiotherapy versus abdominal hysterectomy in patients with adenosquamous carcinoma of the cervix.Methods Patients with adenosquamous carcinoma of the cervix were selected from the Chinese cervical cancer clinical treatment programs.The 2018FIGO staging classification was uesd as the stratification basis to compare the oncological outcomes of patients undergoing radical chemoradiotherapy and those undergoing abdominal hysterectomy.Results(1) Initial cohort:The radical chemoradiotherapy group consisted of 97 cases,while the abdominal hysterectomy group included 373 cases.The 5-year overall survival(OS)and disease-free survival(DFS) rates in the radical chemoradiotherapy group were both inferior to those in the abdominal hysterectomy group(OS:69.2% vs.83.7%,P<0.001;DFS:57.8% vs.81.3%,P<0.001).Cox multivariate analysis indicated that radical chemoradiotherapy was an independent risk factor affecting patient prognosis(OS:HR=2.094,95%CI 1.243-3.530,P=0.006;DFS:HR=2.477,95%CI 1.585-3.871,P<0.001).(2) For FIGO stage Ⅱ B and earlier:36 patients in the chemoradiotherapy group and248 in the abdominal hysterectomy group.There was no statistical difference in 5-year OS and DFS between the two groups(OS:89.9% vs.88.3%,P=0.813;DFS:83.6% vs.86.7%,P=0.510).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=0.731,95%CI 0.152-3.520,P=0.696;DFS:HR=0.726,95%CI 0.218-2.417,P=0.601).(3)For FIGO stage ⅢC:20 patients in the chemoradiotherapy group and 100 in the abdominal hysterectomy group.Both 5-year OS and DFS indicated that the abdominal hysterectomy group had better oncological outcomes(OS:44.6% vs.65.9%,P=0.007;DFS:39.7% vs.61.5%,P=0.012).Cox multivariate analysis suggested no statistical difference in prognosis between the two groups(OS:HR=2.091,95%CI 0.936-4.672,P=0.072;DFS:HR=1.748,95%CI 0.827~3.692,P=0.143).(4) For FIGO stage Ⅲ-Ⅳ:48 patients in the chemoradiotherapy group and 102 in the abdominal hyste

关 键 词：子宫颈肿瘤 根治性放化疗 开腹手术 肿瘤学结局 

分 类 号：R737.3[医药卫生—肿瘤]