中国大陆部分地区局部晚期宫颈癌治疗状况调查及分析

Investigation and analysis of the treatment status of locally advanced cervical cancer in some parts of China's Mainland

目的通过中国宫颈癌多中心临床诊疗大数据,探讨我国局部晚期宫颈癌的治疗现状。方法从中国大陆部分地区34家三级甲等医院收集的2004—2016年共30 665例宫颈癌临床诊疗数据中调取局部晚期宫颈癌(ⅠB2期和ⅡA2期)患者4420例,回顾性分析近13年来局部晚期宫颈癌治疗现状。结果 (1)手术治疗者3908例(88.4%),年龄(45.73±8.53)岁;根治性放化疗者312例(7.1%),年龄(50.56±9.90)岁;70例(1.6%)患者未行治疗,130例(2.9%)患者治疗情况不详。(2)4420例局部晚期宫颈癌中3908例患者选择手术治疗,其中有2315例(59.2%)患者采用术前辅助治疗后再行手术治疗,1593例(40.8%)采取直接手术治疗方式;2004—2016年间,辅助治疗后手术者与直接手术者例数均随时间呈先升高-再下降趋势,但是辅助治疗后手术者升高的曲率高于直接手术者;根据术前辅助治疗方式和途径的不同,选择新辅助静脉化疗者1692例(73.1%),其应用率随时间呈逐年升高趋势,其余术前辅助治疗方式应用率均随时间呈逐年下降趋势。(3)312例行根治性放化疗的局部晚期宫颈癌患者,根治性放化疗联合方案有多种,根据化疗功效和时机分为新辅助化疗+根治性放疗方案130例(41.7%),新辅助化疗+同步放化疗方案77例(24.7%),根治性放疗方案43例(13.8%),同步放化疗方案16例(5.1%),同步放化疗+辅助化疗组31例(占9.9%),根治性放疗+辅助化疗方案15例(4.8%)。结论在中国近13年来,局部晚期宫颈癌患者选择手术治疗的患者明显多于选择根治性放化疗的患者。目前我国根治性放化疗方案多样,以先行诱导化疗后再行根治性放疗或根治性同步放化疗的方案最多见。

Objective To investigate and analyze the current treatment status of locally advanced cervical cancer through the multi-center big data of clinical diagnosis and treatment in China.Methods A total of 4420 patients with locally advanced cervical cancer（ⅠB2 and ⅡA2）were enrolled in from 30 665 cases obtained from 34 tertiary hospitals in China's Mainland from 2004 to 2016.Retrospectively analyze the treatment status of LACC in13 years.Results（1）The 3908 LACC patients with surgery（88.4%）had an average age o（f45.73±8.53）years;312 patients（7.1%）underwent radical chemoradiation,with an average age of（50.56 ± 9.90）years old;70 cases（1.6%）were not treated,and 130 patients（2.9%）were unclear.（2）Of the 4420 cases of LACC patients,3908 patients were treated with surgery.Among them,2315（59.2%）patients underwent surgery after adjuvant therapy,and 1593 patients（40.8%）underwent direct surgery.From 2004 to 2016,both the number of patients who underwent adjuvant therapy and the number of patients receiving direct surgery showed a tendency of rise-fall with time,but the increased curvature of the surgery after adjuvant therapy was higher than that of the direct surgery;according to the different methods and approaches of preoperative adjuvant therapy,the number of patients receiving neoadjuvant intravenous chemotherapy was found to be 1692（73.1%）,and the application rate increased with time,while the application rate of other preoperative adjuvant treatment methods decreased with time.（3）There were 312 patients with LACC who underwent radical chemoradiotherapy.According to the efficacy and the timing of chemotherapy,there were130 patients（41.7%）with neoadjuvant chemotherapy＋radical radiotherapy,77 patients with neoadjuvent chemotherapy＋concurrent radiotherapy（24.7%）,43（13.8%）with radiotherapy alone,16（5.1%）with concurrent chemoradiotherapy,31（9.9%）with concurrent chemoradiotherapy plus adjuvant chemotherapy,and 15 with radical radiotherapy ＋ adjuvant chemotherapy（4.8%）.Conclusion In the past 13 years in China,in the patients with locally advanced cervical cancer,there are significantly more patients choosing surgical treatment than those choosing radical chemoradiotherapy.At present,the radical chemoradiotherapy programs in China are diverse,and the most common treatments are radical radiotherapy or radical concurrent chemoradiotherapy after the inducing chemotherapy.