118例ⅡB～ⅣA期宫颈腺癌单纯放疗与同步放化疗生存情况及其预后因素分析

Survival Status and Prognostic Factors of Radiotherapy and Concurrent Chemoradiotherapy in 118 Patients with FIGO Stage ⅡB-ⅣA Cervical Adenocarcinoma

目的：探讨ⅡB~ⅣA期宫颈腺癌患者采用单纯放疗与同步放化疗的生存情况,并分析影响其预后的相关因素,从而探讨ⅡB~ⅣA期宫颈腺癌较理想的治疗方法。方法：回顾性分析1986年1月至2010年12月于我院接受单纯放疗与同步放化疗治疗的ⅡB~ⅣA期宫颈腺癌患者118例的临床资料,对其生存情况及预后相关因素进行分析。结果：本组病例5年总体生存率为47.5%,行单纯放疗与同步放化疗的5年生存率分别为32.7%和59.1%,差异有统计学意义（P〈0.05）。按分期分层分析：单纯放疗组与同步放化疗组ⅡB期5年生存率分别为48.3%和63.3%,差异无统计学意义（P〉0.05）。ⅢB期5年生存率分别为22.2%和47.1%,差异有统计学意义（P〈0.05）。按组织学分级分层分析：单纯放疗组与同步放化疗组5年生存率G1分别为42.9%和61.9%,差异无统计学意义（P〉0.05）;G2分别为33.3%和55.2%,G3分别为18.2%和50.0%,差异均有统计学意义（P〈0.05）。单因素分析与多因素分析均提示临床分期、组织学分级、肿瘤最大径线及治疗方法是影响ⅡB~ⅣA期宫颈腺癌预后的独立因素（P〈0.05）。结论：ⅡB~ⅣA期宫颈腺癌单纯放疗与同步放化疗相比,同步放化疗有一定优势,尤其是对ⅢB期及组织学分级G2、G3的患者,能够提高5年生存率。临床分期、组织学分级、肿瘤最大径线及治疗方法是影响ⅡB~ⅣA期宫颈腺癌预后的因素。

Objective：To compare the survival of patients with FIGO stage Ⅱ B-ⅣA cervical adenocarcinoma treated with radiotherapy and concurrent chemoradiotherapy, and to analyze the related prognostic factors, and thus to investigate the suitable treatment for stage Ⅱ B-ⅣA cervical adenocarcinoma. Methods：The clinical data of 118 cases with stage Ⅱ B-ⅣA cervical adenocarcinoma from January 1986 to December 2010 in Beijing Obstetrics and Gynecology Hospital were collected and sorted. The survival and prognostic factors were analyzed. Results：The 5-year overall survival rate was 47.5% of all cases,and it was 32.7% and 59. 1% in the radiotherapy group and the concurrent chemoradiotherapy group, respectively, and the difference was statistically significant（ P 〈 0.05）. Stratified analysis based on the stage showed：The 5-year survival rate of stage Ⅱ B cases was 48.3% and 63.3% in the radiotherapy group and concurrent chemoradiotherapy group, respectively, and there was no statistically significant difference（P〉0.05）. While it was 22.2% and 47. 1% in stage ⅢB patients in the radiotherapy group and concurrent chemoradiotherapy group, respectively,and the difference was statistically significant（ P 〈 0.05）. Stratified analysis based on the histological grade showed ：The 5-year survival rate of G1 was 42.9% and 61.9% in radiotherapy group and concurrent chemoradiotherapy group, respectively, and the difference was not statistically significant（ P 〉 0.05）. The 5-year survival rate of G2 was 33.3% and 55.2%, and it of G3 was 18.2% and 50.0%, in radiotherapy group and concurrent chemoradiotherapy group, respectively, both differences were statistically significant（ P 〈 0.05）. The univariate analysis and the multivariate analysis showedthat the clinical stage, histological grade, maximum tumor diameter and treatment were the independent factors related to prognosis of stage Ⅱ B-ⅣA cervical adenocarcinoma（ P 〈 0.05 ）. Conclusions. Concurrent chemoradiotherapy could improve 5-year survival rate compared with radiotherapy in patients with stage Ⅱ B-ⅣA cervical adenocarcinoma, especially in cases with stage Ⅱ B and histological grade G2 and G3. The clinical stage, histological grade, maximum tumor diameter and treatment are the independent factors related to prognosis of stage Ⅱ B- ⅣA cervical adenocarcinoma.