三维适形放射治疗联合化疗对中晚期宫颈癌患者血清细胞角蛋白19片段抗原21-1和鳞状细胞癌抗原水平变化的影响

Effect of 3D-CRT combined with chemotherapy on serum levels of CYFRA21-1 and SCC-Ag in patients with advanced cervical cancer

目的探讨三维适形放射治疗(3D-CRT)联合顺铂和紫杉醇化疗(PT化疗方案)对宫颈癌中晚期患者血清细胞角蛋白19片段抗原21-1(CYFRA21-1)和鳞状细胞癌抗原(SCC-Ag)水平变化及生活质量的影响。方法选取2011年4月至2014年4月间四川省人民医院友谊医院收治的94例宫颈癌中晚期患者,依照治疗方案不同分为观察组与对照组,每组47例。对照组患者采用3DCRT治疗,观察组患者采用3D-CRT联合PT化疗方案治疗,比较两组患者临床效果、不良反应发生情况及治疗前后血清CYFRA21-1和SCC-Ag水平,并对比两组患者治疗前、治疗后1年生活质量评分(SF-36)与治疗后1年、2年和3年生存率。结果观察组患者总有效率为85.1%(40/47),高于对照组患者的66.0%(31/47),组间比较,差异有统计学意义(P<0.05)。治疗前,两组患者血清CYFRA21-1和SCC-Ag水平比较,差异无统计学意义(P>0.05);治疗后,与对照组比较,观察组患者血清CYFRA21-1和SCC-Ag水平均较低,差异均有统计学意义(均P<0.05)。治疗后1年,两组患者SF-36评分均较治疗前提高,且观察组高于对照组,差异均有统计学意义(均P<0.05)。治疗后3年,观察组患者生存率为78.7%(37/47),高于对照组的59.6%(28/47),组间比较,差异有统计学意义(P<0.05)。两组患者放射性膀胱炎、放射性直肠炎、骨髓抑制及消化道反应发生率比较,差异无统计学意义(P>0.05)。结论宫颈癌中晚期患者采用3D-CRT联合PT化疗方案治疗,疗效确切,可有效降低血清CYFRA21-1和SCC-Ag水平,提升生存质量,延长生存时间,且安全性高。

Objective To investigate the effect of three dimensional conformal radiotherapy（3DCRT） combined with PT chemotherapy（cisplatin plus paclitaxel） on serum levels of cytokeratin 19 fragment antigen 21-1（CYFRA21-1） and squamous cell carcinoma antigen（SCC-Ag） and quality of life in patients with advanced cervical cancer. Methods A total of 94 patients with advanced cervical cancer at Sichuan Provincial People＇s Hospital Friendship Hospital from April 2011 to April 2014 were selected and divided into an observation group and a control group according to the therapeutic regimen with 47 patients in each group. The observation group was treated with 3D-CRT combined with PT chemotherapy and the control group was treated with 3D-CRT. The clinical efficacy,adverse reactions and serum levels of CYFRA21-1 and SCC-Ag before and after the treatment were compared between the two groups. The quality of life score（SF-36） before and after 1 year of the treatment and the survival rates at 1 year,2 years and3 years after the treatment were compared between the two groups. Results The overall efficacy rate of the observation group was 85. 1%（40/47） which was higher than 66. 0%（31/47） of the control group（P〈0. 05）. Before the treatment,there was no significant difference in serum CYFRA21-1 and SCC-Ag levels between the two groups（P〉0. 05）. After the treatment,the serum levels of CYFRA21-1 and SCC-Ag decreased in the observation group compared with the control group（P〈0. 05）. At 1 year after the treatment,SF-36 scores were increased in the two groups compared with before the treatment with the observation group higher than the control group（P〈0. 05）. Ther survival rate was 78. 7%（37/47） at 3 years after the treatment in the observation group which was higher than 59. 6%（28/47） of the control group（P〈0. 05）. There was no significant difference in radiation cystitis,radiation proctitis,bone marrow suppression and gastrointestinal reactions between the two groups（P〉0.05）. Conclusion 3D-CRT combined with PT chemotherapy has got definite efficacy in treating advanced cervical cancer. It can effectively reduce the serum CYFRA21-1 and SCC-Ag levels,improve the quality of life and prolong the survival time with high safety.