中晚期子宫颈鳞癌同步放化疗的疗效及预后因素分析

Outcomes and prognostic factors of advanced squamous cervical cancer after concurrent chemoradiotherapy

目的 探讨中晚期子宫颈鳞癌患者同步放化疗的疗效及预后相关因素.方法 回顾性分析2007年1月至2008年12月在中国医学科学院肿瘤医院接受同步放化疗的172例Ⅱb～Ⅳ期子宫颈鳞癌患者的临床病理资料,均接受了体外放疗、腔内近距离放疗及以顺铂为基础的同步化疗.结果 172例患者的中位随访时间为54.5个月,2年总生存率（OS）和5年OS分别为81.5％和68.8％,2年无进展生存率（PFS）和5年PFS分别为69.2％和63.1％.单因素分析显示,影响OS的因素有肿瘤分期（Ⅱb期与Ⅲ期及以上,P＜0.01）、局部肿瘤最大直径（≤4与＞4 cm,P=0.001）、治疗前血清鳞状细胞癌抗原（SCC）水平（≤3与＞3μg/L,P=0.001）、影像学腹膜后淋巴结转移情况（腹主动脉旁淋巴结阳性、仅盆腔淋巴结阳性与腹膜后淋巴结阴性,P＜0.01）、血红蛋白含量（≤90、90 ～ 100与≥100 g/L,P=0.040）.对PFS有显著影响的临床因素包括肿瘤分期（P＜0.01）、局部肿瘤最大直径（P =0.003）、治疗前SCC水平（P =0.001）、影像学腹膜后淋巴结转移情况（P＜0.01）.多因素分析显示,Ⅲ期及以上（P =0.021,P=0.020）、局部肿瘤最大直径＞4 cm（P=0.009,P=0.033）、治疗前SCC水平＞3 μg/L（P =0.010,P =0.013）、影像学腹膜后淋巴结阳性（P =0.025,P=0.024）这4个因素是影响患者OS和PFS的独立不良因素,其中影像学腹主动脉旁淋巴结阳性（P=0.009,P=0.010）、仅盆腔淋巴结阳性（P=0.044,P=0.033）均为影响患者OS和PFS的独立不良因素.按预后不良因素数量将患者分为：无预后不良因素者（18例）,有1个预后不良因素者（43例）,有≥2个预后不良因素者（111例）,无不良因素者与有1个不良因素者的OS、PFS分别比较,差异均无统计学意义（P＞0.05）,有≥2个不良因素者（2年、5年OS分别为73.1％、58.6％,2年、5年PFS分别为57.9％、50.0％）分别与前两者比较,差异均有统计学意义（P＜0.05）.结论 Ⅲ期及以上、局部肿瘤最大直径＞4 cm、治疗前SCC＞3μg/L和影像学腹膜后淋巴结阳性是行同步放化疗的中晚期子宫颈鳞癌患者的独立预后不良因素,有≥2个不良因素的患者疗效较差.

Objective To evaluate the outcomes and the prognostic factors for advanced squamous cervical cancer after concurrent chemoradiotherapy （CCRT）.Methods Totally 172 patients with International Federation of Gynecology and Obstetrics stage Ⅱ b-Ⅳ who were treated in Cancer Hospital,Chinese Academy of Medical Sciences between January 2007 and December 2008 were retrospectively analyzed.Patients were received external radiotherapy,high-dose rate brachytherapy and cisplatin-based chemotherapy concurrently.Results The median follow-up period was 54.5 months.The 2-year and 5-year overall survival （OS） were separately 81.5% and 68.8%.The 2-year and 5-year progress-free survival （PFS） were separately 69.2% and 63.1%.Using univariate analysis followed with multivariate analysis,the results showed that these clinicopathological factors including stage （Ⅲ and above versus Ⅱ b; P =0.021,HR =1.95 ; P =0.020,HR =1.86）,maximum diameter of local tumor size （〉4 versus ≤4 cm; P =0.009,HR =2.55 ; P =0.033,HR =1.94）,squamous cell carcinoma antigen （SCC） level before treatment （〉3 versus ≤3 μg/L; P =0.010,HR =2.47; P =0.013,HR =2.09） and retroperitoneal lymph node status on imaging （para-aortic lymph node positive versus negative,P =0.009,HR =3.00,P=0.010,HR =2.74; pelvic lymph node positive only versus negative,P =0.044,HR =1.98,P =0.033,HR =1.92） had the significant effect on OS and PFS.Patients with no above adverse prognostic factor were assigned to Group A （n =18）,those with one factor were assigned to Group B （n =43）,and those with no less than two factors were assigned to Group C （n =1 11）.Among three groups,the 2-year OS were separately 94.1%,97.7% and 73.1%,the 5-year OS were separately 81.4%,90.1% and 58.6%,the 2-year PFS were separately 88.2%,90.4% and 57.9%,the 5-year PFS were 82.4%,87.9% and 50.0%.The results showed that group C was significant difference from Group A or B in OS and PFS （all P 〈 0.05）,while Group A had no significant difference from Group B in OS and PFS （P 〉 0.05）.Conclusions Stage Ⅲ or above,maximum diameter of local tumor size 〉 4 cm,SCC level 〉 3 μg/L before treatment and positive retroperitoneal lymph nodes on imaging are four independent adverse factors for prognosis of squamous cervical cancer of advanced stage after CCRT.The treatment of patients with no less than two adverse factors should be considered to be improved.