Ⅱa-Ⅱb期宫颈癌根治术加术前同期放化疗与根治性放疗同期化疗的临床疗效比较

Clinical effects of radical hysterectomy plus preoperative radiochemotherapy and radical radiotherapy with concurrent chemotherapy: a comparative study of patients with FIGO stage Ⅱa- Ⅱb cervical cancer

目的比较Ⅱ期宫颈癌根治术加术前同期放化疗与根治性放疗同期化疗的临床疗效、预后因素及远期不良反应。方法回顾分析大连市第三人民医院妇瘤科2001年1月—2008年12月收治的207例Ⅱa-Ⅱb期宫颈鳞癌患者的临床资料。119例行根治术结合术前同期放化疗(手术组),88例行根治性放疗及同期化疗(放化疗组),化疗方案为PF/TP。观察两组间的5年无进展生存(PFS)、总生存(OS)及远期不良反应的发生率。结果患者5年总生存率(OS)为手术组73.95%,放化疗组54.02%;总无进展生存率(PFS)为手术组71.43%,放化疗组49.43%。78例复发,其中51例(65%)为局部复发,18例(23%)为远处转移,9例(12%)为局部复发+远处转移。单因素及多因素分析均显示,治疗前SCC值、治疗后1个月SCC值是否降至<1.5 mg/L及是否手术这3个因素与总生存时间相关(RR分别为0.066、0.045、2.604,P均<0.05)。手术组下肢水肿、生殖道瘘发生率较高(P均<0.05),放化疗组放射性肠炎、膀胱炎发生率较高(P均<0.05)。结论Ⅱ期宫颈鳞癌患者,根治术联合术前同期放化疗能获得较好预后。治疗前SCC值≥1.5 mg/L,治疗后1个月SCC值未下降至<1.5 mg/L及未行手术治疗者预后较差。

Objective To compare the clinical efficacy,prognosis and long- term toxicities of radical surgery plus preoperative chemoradiotherapy with radical radiotherapy plus concurrent chemotherapy in the treatment of stage IIa and IIb cervical carcinoma patients. Methods Retrospective analysis was performed on 207 patients with stage Ⅱ squamous cervical carcinoma in our Hospital from January 2001 to December 2008. 119 patients received radical surgery and preoperative chemoradiotherapy（ RHT） and 88 Patients received radical radiotherapy and concurrent chemotherapy（ RCT） with PF or TP chemotherapy regimen. 5- year overall survival rate,5- year progression free survival rate and incidence rate of early and late side- effect were analyzed. Results In the 207 patients,the 5- year overall survival rate（ OS） was 73. 95% in group RHT and 54. 02% in group RCT; the 5- year disease- free survival rate（ PFS） was 71. 43% in group RHT and 49. 43% in group RCT. 78 patients had recurrent cancer with either local recurrences（ 51 patients,65%）,distant metastases（ 18 patients,23%） or both（ 9 patients,12%）. Univariate and multivariate analysis showed that overall survival time was correlated to squamous cell carcinoma antigen（ SCC） levels before and 1 month after treatment and whether received surgery（ RR = 0. 066,0. 045 and 2. 604,respectively,P〈0. 05）. Leg edema and urogenital fistula occurred more frequently in group RHT than in group RCT（ all P〈0. 05）,while radiation enteritis and radiation urocystitis more frequently in group RCT than in group RHT（ all P〈0. 05）. Conclusions By radical surgery with preoperative radiochemotherapy,stage IIa and IIb squamous cervical carcinoma patients obtained better prognosis. Patients who had SCC level ≥1. 5 mg / L before treatment,SCC level ≥1. 5 mg / L 1 month after treatment and without surgery had poor prognosis.