放化疗对宫颈癌术后复发高危与中危患者生存质量的影响

Effect of radiation and chemotherapy on the survival quality of patients of postoperative high and moderate recurrence of cervical cancer

目的:分析放化疗对于预防宫颈癌术后不同复发危险程度患者的复发、转移的可行性,及对不同复发危险程度患者的术后生存时间影响。方法:选择2012年1月至2012年12月采取手术治疗的Ⅰb-Ⅱa期宫颈癌患者,根据手术病理结果评估复发危险性,将其中的高危与中危患者作为本次研究对象,其中高危患者26例为高危组,中危患者31例为中危组;术后两组患者均进行放化疗预防复发。对比两组患者的手术参数,术后并发症情况;随访3年,对比两组患者的复发率、转移率,评估患者心理状态与生存质量,并以无进展生存曲线及总生存曲线对比法分析术后放化疗对于不同复发危险程度患者生存时间的影响。结果:两组手术用时、术中出血量及手术并发症发生率比较差异无统计学意义(P>0.05);中危组3年内复发转移率为6.45%,高危组3年内复发转移率为15.38%,两组比较差异无统计学意义(P>0.05);高危组与中危组患者放化疗后1个月内不良反应比较差异无统计学意义(P>0.05);高危组患者焦虑程度(SAS)较中危组严重(t=2.208,P<0.05),高危组患者抑郁程度(SDS)较中危组严重(t=3.189,P<0.05),高危组患者生活质量低于中危组(t=4.723,P<0.05);高危组患者无癌生存时间、三年总生存时间与中危组比较差异无统计学意义(P>0.05)。结论:对宫颈癌患者于术后进行复发危险性评估,据此进行预防性放化疗,可有效降低复发率与转移率,通过术后放化疗可使复发高危患者的生存时间与中危患者持平,降低高危患者的复发风险;并且术后放化疗的不良反应患者均可耐受具有临床可行性。

Objective ：To analyze the feasibility of radiation and chemotherapy in cervical cancer prevention of postoperative recurrence of different degree of risk of recurrence and metastasis, and the effects on postoperative survival time in patients with different degree of recurrence risk. Methods： Recurrence risk assessment was made on cervical cancer patients of I b - II a period from January 2012 and December 2012 according to the results of the surgical pathology. 26 high - risk patients were in the high -risk group and 31 moderate risk patients were in the moderate group. Both groups were given radiation and chemotherapy to prevent recur- rence. The surgical parameters and postoperative complications were compared in the two groups. In the 3 years follow - up, the rates of metastasis and recurrence were compared, and the patients＇psychological status and quality of life were evaluated. Progression -free survival curve and the total survival curve correlation method were used to analyze the effects of radiation and chemotherapy on survival time in patients with different degree of recurrence risk. Results：There was no statistically significant difference of operation time, intraoperative blood loss and operative complications between the two groups （ P 〉 0. 05 ）. The recurrence rate within 3 years was 6.45 % in the moderate risk group and 15.38 % in the high - risk group, and the difference was not statistically significant （ P 〉 0.05）. There was no statistically significant difference in adverse reaction within one month between the high - risk group and moderate risk group （ P 〉 0.05 ）. Compared with moderate risk group, the anxiety level （SAS） in the high -risk group was more severe （ t =2.208, P 〈 0.05）, the depression level （SDS） was more severe （ t =3. 189, P 〈 0.05 ）, and the quality of life was lower （ t =4. 723, P 〈 0.05 ）. There was no statistically significant difference in the survival time and the total survival time with- in three years between the two groups （ P 〉0.05）. Conclusion：Postoperative recurrence risk assessment should he conducted in patients with cervical cancer, on the basis of which preventive radiation and chemotherapy will be given. It can effectively reduce the rate of recurrence and metastasis, and reduce the recurrence risk of high -risk patients, which has clinical feasibility.