603例中晚期宫颈癌患者放射治疗预后的多因素生存分析

Analysis of Multiple Prognostic Factors in 603 Radiotherapy Patients with Mid-stage and Advanced-stage Uterine Cervix Carcinoma

目的探讨中晚期宫颈癌患者放射治疗预后的影响因素,为宫颈癌的临床诊疗和预后评估提供参考。方法回顾性分析603例中晚期宫颈癌患者的临床资料,分析病例的临床特点及预后因素,生存单因素分析采用Kaplan-Meier法,并进行Log-rank时序检验;多因素分析采用Cox逐步回归模型。结果中位随访时间为31月,1,2,3年的生存率分别为91.5%,88.4%,86.9%。Kaplan-Meier生存分析提示,确诊时肿瘤的分化程度、FIGO分期、是否淋巴结转移、是否合并心血管疾病等并发症、治疗前是否贫血、治疗过程中是否同步放化疗、是否应用调强放疗及是否配合热疗与预后相关;多因素分析显示,确诊时是否合并淋巴结转移及治疗中是否配合热疗是影响中晚期宫颈癌患者预后的独立因素。结论中晚期宫颈癌患者确诊时是否合并淋巴结转移及治疗中是否配合热疗是影响中晚期宫颈癌患者预后的独立因素。确诊时对患者病情进行详尽评估可以更好地预测其预后,治疗过程中配合热疗等综合治疗可有效延长患者的远期生存率。

Objective To explore prognostic factors in patients of radiotherapy with mid-stage and advanced-stage uterine cervix carcinoma and to provide reference for clinical diagnosis,treatment,and prognosis evaluation of cervix carcinoma. Method Data of 603 cases with mid-stage and advanced-stage uterine cervix carcinoma were retrospectively analyzed,and statistical methods were used to analyze clinical features and prognostic features of the case. Kaplan-Meier method and Log-rank were adopted for survival single factor analysis,and Cox stepwise regression model was used for multiple-factor analysis. Result The follow-up time(median)was 31 months,and the 1,2 and 3-year survival rates were 91.5%,88.4%and 86.9%respectively. As indicated by Kaplan-Meier survival analysis,tumor differentiation upon diagnosis,FIGO staging,lymphatic metastasis,concurrent cardiovascular disease and other complications,pre-treatment anemia,concurrent radiochemotherapy during a therapeutic course,application of intensity modulated radiotherapy,and supportive thermal therapy were related with patients’prognosis. It is indicated by multi-factor analysis that concurrent lymphatic metastasis upon diagnosis and supportive thermal therapy during a therapeutic course were independent factors for prognosis of patients with mid-stage and advanced-stage uterine cervix carcinoma. Conclusion In patients with mid-stage and advanced-stage uterine cervix carcinoma,concurrent lymphatic metastasis upon diagnosis,and supportive thermal therapy during a therapeutic course are independent factors for the prognosis. Detailed evaluation of a patient’s condition upon diagnosis facilitates better prediction of her prognosis,and supportive thermal therapy during a therapeutic course and other comprehensive therapeutic approaches effectively improve long-term survival rate of the patients.