不同放疗方案对宫颈癌根治术后复发伴转移患者的近远期疗效及预后影响因素分析

Influencing Factors of Different Radiotherapy Regimens on Short-term and Long-term Efficacy and Prognosis of Patients Having Recurrence and Metastasis after Radical Operation for Cervical Cancer

目的探讨不同放疗方案对宫颈癌根治术后复发伴转移患者的近远期疗效,并分析其预后影响因素。方法对2013年3月—2015年6月96例宫颈癌根治术后复发伴转移患者的临床资料进行回顾性分析,并根据放疗方案的不同将患者分为观察组和对照组,每组48例。对照组给予后程调强放疗加量方案,观察组给予同期调强放疗加量方案。比较2组的近期、远期疗效及毒副反应发生情况,并通过Cox回归分析患者的预后危险因素。结果治疗后,观察组的近期总有效率、疾病控制率、中位总生存期和3年生存率均高于对照组(P<0.05)。观察组脊髓抑制发生率低于对照组(P<0.05)。有脉管瘤栓、肿瘤直径>4cm、切缘阳性、淋巴结转移数目>3个是影响宫颈癌根治术后复发伴转移患者预后的独立危险因素(P<0.05)。结论应用同期调强放疗加量方案治疗可提高宫颈癌根治术后复发伴转移患者的近期疗效,延长生存时间,治疗过程中应注意上述影响患者预后的独立危险因素。

Objective To investigate short-term and long-term efficacy of different radiotherapy regimens in treatment of patients having recurrence and metastasis after radical operation for cervical cancer, and to analyze influencing factors of prognosis. Methods Clinical data of 96 patients having recurrence and metastasis after radical operation for cervical cancer admitted during March 2013 and June 2015 was retrospectively analyzed and the patients were divided into observation group and control group ( n =48 in each group) according to different radiotherapy schemes. Control group was given posterior integrated boost intensity-modulated radiation therapy, while observation group was given simultaneous integrated boost intensity-modulated radiation therapy. In two groups, short-term and long-term efficacy and incidence rate of toxic and side effects were compared, and prognostic risk factors were analyzed by Cox regression. Results After treatment, in observation group, values of short-term total effective rate, disease control rate, median total survival time and 3-year survival rate were significantly higher than those in control group ( P <0.05);incidence rate of spinal cord inhibition was significantly lower than that in control group ( P <0.05). Vascular tumor embolus, tumor diameter more than 4 cm, positive margin of incision and number of lymph node metastases more than 3 were independent risk factors affecting prognosis of patients having recurrence and metastasis after radical operation for cervical cancer ( P <0.05). Conclusion Simultaneous integrated boost intensity-modulated radiation therapy may improve short-term efficacy and prolong survival time of patients having recurrence and metastasis after radical operation for cervical cancer. During the course of treatment, independent risk factors affecting prognosis should be paid attention.