早期宫颈腺鳞癌和腺癌术后同步放化疗疗效分析

Efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma

目的回顾分析早期宫颈腺癌、腺鳞癌术后同步放化疗的疗效。方法收集2006～2012年ⅠB-ⅡA期宫颈腺鳞癌62例、腺癌149例、鳞癌2687例，部分术后盆腔±腹主动脉延伸野±后装放疗，行DDP、TP和FP化疗。一般临床资料并。检验，Kaplan—Meier法生存分析并Logrank检验。结果腺癌和腺鳞癌的临床病理特征相近（肿瘤大小、间质浸润、淋巴结转移、宫体受侵、病理分级、病变类型的P=0．639、0．107、0．522、0．956、0．204、0．182），高危腺癌即使辅助放（化）疗复发率仍高于低危患者（P=0．000）。手术＋放疗中位生存期似乎腺鳞癌〈腺癌〈鳞癌（腺鳞癌比腺癌P=0．787；腺癌比鳞癌P=0．134；腺鳞癌比鳞癌P=0．582）：手术＋同步放化疗中位生存期似乎腺癌〈腺鳞癌〈鳞癌，腺癌与鳞癌间不同（腺癌比腺鳞癌P=0．131；腺鳞癌比鳞癌P=0．643；腺癌比鳞癌P=0．000）。腺鳞癌、腺癌术后同步放化疗比术后放疗的近期不良反应率均更高（P=0．037、0．003），远期不良反应相近（P=0．861、0．655）。腺鳞癌术后同步放化疗较术后放疗远处转移率低（P=0．003），中位OS、DFS期似乎延长了17个月（P=0．811、0．799）；腺癌似乎分别减少了11个月和9个月（P=0．330、0．115）。结论早期高危宫颈腺鳞癌术后同步放化疗较放疗可减少远处转移率，腺鳞癌和腺癌术后同步放化疗较放疗并不改善生存期。

Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma. Methods A total of 62 patients with cervical adenosquamous carcinoma, 149 patients with cervical adenocarcinoma, and 2687 patients with cervical squamous cell carcinoma, all of whom were in stage ⅠB-ⅡA and were treated from 2006 to 2012, were enrolled, and some of them received postoperative pelvic radiotherapy ＋ para-aortic extended field radiation _＋afterloading radiotherapy. The chemotherapy regimen consisting of DDP, TP, and FP was given to these patients. The chi-square test was used for comparison of general clinical data, the Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis. Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features （P= 0. 107-0. 639）. The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy （P= 0. 000）.In the patients treated with surgery and radiotherapy, those with adenosquamous carcinoma had the shortest median survival time, followed by those with adenocarcinoma and squamous cell carcinoma （P= O. 134, 0.787）; in the patients treated with surgery and concurrent chemoradiotherapy, those with adenocarcinoma had the shortest median survival time , followed by those with adenosquamous carcinoma and squamous cell carcinoma （P = 0. 131,0. 643） , and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma （P= 0. 000）. In the patients with adenosquamous carcinoma and adenocarcinoma, the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy （P= 0. 037,0. 003 ）, but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients （ P= 0. 861, 0. 655）. In the patients with adenosquamous carcinoma, the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis （P = 0. 003） and prolonged median overall survival and disease-free survival （both increased by 17 months ） （ P= 0. 811, 0. 799 ） , as compared with those treated with postoperative radiotherapy, while in the patients with adenocarcinoma, the median overall survival and disease - free survival were reduced by 11 and 9 months , respectively （ P= 0. 330,0. 115 ） . Conclusions Compared with postoperative radiotherapy, postoperative concurrent chemoradiotherapy for early-stage high- risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis. Compared with radiotherapy, postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.