不同治疗方式对术后伴中危因素Ⅰ-ⅡA期宫颈癌预后影响

Effect of different therapeutic methods on survival of stage Ⅰ-ⅡA cervical cancer patients complicated with postoperative intermediate risk factors

目的比较不同治疗方式对伴中危因素的Ⅰ-ⅡA期宫颈癌患者的生存差异,探讨早期宫颈癌术后伴中危因素患者的最佳治疗模式。方法回顾分析2007-2016年间收治的包含中危因素的323例宫颈癌术后患者,比较观察(NT)、单纯化疗(CT)、放疗(RT)及同步放化疗(CCRT)方式对生存的影响。Kaplan-Meier法生存分析,Logrank检验差异,Cox模型行预后因素分析。结果全组的5年PFS、OS为79.0%、84.8%。单因素及多因素分析肿瘤大小>4 cm、治疗方式是影响PFS的因素(P=0.017、0.002),危险因素个数、治疗方式是影响OS的因素(P=0.042、0.000)。全组中RT及CCRT均可改善患者预后(P=0.007、0.000)。亚组分析中任意1个中危因素(低危组),CT能够延长5年PFS (P=0.026),在改善5年OS上相近(P=0.692);与NT及CT相比,RT及CCRT均能改善患者预后(P=0.006、0.000),但RT与CCRT相近(P=0.820、0.426)。≥2个中危因素(高危组)中,与CT相比,CCRT能提高患者的5年PFS (P=0.006),但不能延长患者5年OS (P=0.107);RT与CCRT比较,CCRT均可改善患者的预后(P=0.028、0.039)。结论仅有1个中危因素时,RT也能改善预后;伴有≥2个中危因素时,CCRT更能改善患者的预后.

Objective To compare the effect of different therapeutic methods upon the survival of stage Ⅰ-Ⅱ A cervical cancer patients with intermediate risk factors and explore the optimal treatment for patients with early-stage cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy.Methods Clinical data of 323 patients with the following intermediate risk factors of lymphovascular space invasion,depth of stromal invasion or tumor size > 4 cm were retrospectively analyzed.The impact of observing (NT),chemotherapy (CT),radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) on survival was statistically compared.The Kaplan-Meier method was used to survival analysis,and log-rank test difference,Cox model was used to prognostic factor analysis.Results The 5-year progression-free survival (PFS) and overall survival (OS) of all patients were 79.0% and 84.8%.Univariate and multivariate analyses demonstrated that TS> 4 cm and therapeutic method were the independent prognostic factors of PFS.The number of risk factors and therapeutic method were the independent prognostic factors of OS.In the whole group,both RT and CCRT could improve the prognosis of patients with no statistical significance (P>0.05).In the subgroup analysis,for patients with a single intermediate risk factor (low risk group),CT could significantly prolong the PFS (P=0.026) rather the 5-year OS (P=0.692).Compared with NT and CT,RT and CCRT could improve the PFS and OS,whereas no statistical significance was noted between the RT and CCRT (both P>0.05).For those with ≥2 risk factors (high risk group),CCRT could significantly prolong the PFS compared with CT (84.9% vs.70%;P=0.006),but did not improve the OS (P=0.107).Compared with RT,CCRT could significantly improve the PFS and OS (both P<0.05).Conclusion For patients with only one risk factor,RT can enhance the clinical prognosis.CCRT can improve the clinical prognosis of stage Ⅰ-Ⅱ A cervical cancer patients with ≥ 2 risk factors.