116例早期子宫颈鳞癌初次治疗后复发患者的预后影响因素及治疗模式分析

Analysis of prognostic factors and therapeutic patterns of recurrent stageⅠb-Ⅱa cervical squamous carcinoma treated with radical hysterectomy

目的探讨早期(Ⅰb~Ⅱa期)子宫颈鳞癌初次治疗后复发患者的预后影响因素,并分析其适当的治疗模式.方法收集2007年1月—2015年7月于中国医学科学院北京协和医学院肿瘤医院接受初次治疗的Ⅰb~Ⅱa期子宫颈鳞癌复发患者共116例的临床病理资料,回顾性分析年龄、初次手术后辅助治疗方法、复发部位、复发与初次治疗的间隔时间(TFI)及复发后治疗模式(包括限定性局部治疗和姑息性化疗)对患者预后的影响,并分析其适当的治疗模式;对其中只能采用姑息性化疗的患者,进一步分析TFI、复发部位、化疗方案对化疗效果的影响.结果(1)116例早期子宫颈鳞癌复发患者的年龄为(45.6±7.2)岁;复发治疗后的3年无进展生存率和3年总生存率分别为30.2%和42.2%.单因素分析显示,初次手术后放疗、复发部位、TFI和复发后的治疗模式对患者复发治疗后的3年无进展生存率有显著影响(P<0.05),初次手术后放疗、TFI及复发后的治疗模式对患者复发治疗后的3年总生存率有显著影响(P<0.05);对复发后治疗模式的进一步分析显示,47例行限定性局部治疗患者的3年无进展生存率和3年总生存率(分别为36.2%、59.6%)显著高于69例行姑息性化疗者(分别为26.1%、30.4%,P<0.01).多因素分析显示,TFI、复发后的治疗模式是影响患者复发治疗后3年无进展生存率的独立因素(P<0.05);初次手术后放疗、TFI及复发后的治疗模式是影响患者复发治疗后3年总生存率的独立因素(P<0.05).(2)69例复发后行姑息性化疗的患者中,完全缓解15例(21.7%),部分缓解16例(23.2%),总反应率(ORR)为44.9%.TFI≥12个月患者的ORR显著高于TFI<12个月者(P<0.01);采用紫杉醇+铂类药物方案化疗患者的ORR显著高于采用其他方案者(P<0.05),其中采用顺铂与采用其他铂类药物化疗患者的疗效比较无明显差异(P=0.408).结论对于早期子宫颈鳞癌初次治疗后复发的患者,复发后的治疗模式、初次手术后是否放疗及TFI均为影响其预后的独立因素.采用限定性局部治疗模式可明显改善早期子宫颈鳞癌复发患者的预后;而对于只能选择姑息性化疗的患者,TFI是预测化疗效果的重要指标,化疗方案应首选紫杉醇与铂类药物的联合方案.

Objective To analyze the prognosis and appropriate treatment modalities of the patients with recurrence of early stage(Ⅰb-Ⅱa)cervical squamous cancer primarily treated with radical hysterectomy.Methods This retrospective study included patients with International Federation of Gynecology and Obstetrics(FIGO)stageⅠb andⅡa recurrent cervical squamous cancer who underwent radical hysterectomy primarily from January 2007 to July 2015.Kaplan-Meier method and Cox regression analysis were performed to analyze related prognostic factors of overall survival and progression-free survival,which included age,postoperative therapy,the site of recurrence,therapy-free interval(TFI)and treatment modality.The patients who were treated with palliative chemotherapy after recurrence were selected as a subgroup.The responses of palliative chemotherapy were evaluated and analyzed among different factors,included TFI,the site of recurrence and chemotherapy regime.Results Of the 2 071 patients,116 relapsedⅠb-Ⅱa cervical squamous cancer were included in the study with the average age of(45.6±7.2)years old.3-year progression-free survival rate and 3-year overall survival rate after recurrence were 30.2%and 42.2%,respectively.Univariate analysis implied that postoperative radiotherapy,recurrence site,TFI and treatment modality were associated with progression-free survival(P<0.05),while postoperative radiotherapy,TFI and treatment modality with overall survival(P<0.05).Multivariate analysis showed that TFI and treatment modality were independent prognostic factors for progression-free survival(P<0.05),while postoperative radiotherapy at initial treatment,TFI and treatment modality were independent prognostic variables for overall survival(P<0.05).In the analysis of treatment modality,3-year progression-free survival rate and 3-year overall survival rate of 47 patients who were treated with definitive local therapy were significantly higher than that of 69 patients who were treated with palliative chemotherapy(P<0.01).In the subgroup analysis of palliative chemotherapy,15 patients achieved complete response(21.7%)and 16 displayed partial response(23.2%).The overall response rate(ORR)was 44.9%.TFI(P<0.01)and chemotherapy regime(P<0.05)were significant factors associated with ORR.The ORR of TFI≥12 months was significantly higher than that of TFI<12 months.Besides,the ORR of paclitaxel plus platinum chemotherapy was prominently higher than that of other regimens,while there was no significant difference between the ORR of paclitaxel plus cisplatin and other platinum(P=0.408).Conclusions For recurrent stageⅠb-Ⅱa cervical squamous carcinoma treated with radical hysterectomy,use of definitive local therapy for suitable patients is advised to achieve better prognosis.In terms of palliative chemotherapy,longer TFI may mean better ORR and the combination of paclitaxel plus platinum is preferred.