城乡差异对宫颈癌病情进展及放射治疗预后的影响

Effects of urban and rural differences on the progression and prognosis of radiotherapy for cervical cancer

目的:通过分析甘肃省宫颈癌患者诊疗资料,进一步探讨城乡居民宫颈癌发病特点及治疗预后的差异。方法: 812例经病理确诊宫颈癌患者按户籍差别分为城镇组( n =324)和农村组( n =488)。所有患者完成根治性放疗计划:外照射采用8MV-X射线照射(盒式四野放射治疗或三维适形放射治疗),剂量32~44 Gy,后予子宫旁加量照射至总剂量46~58 Gy;外照射同期宫颈腔内近距离放疗30~42 Gy/(5~6次)。151例患者因病程中阴道出血严重或子宫颈瘤体较大而接受单次子宫动脉介入化疗栓塞术治疗。681例患者放疗同步接受全身化疗。结果:城镇组1年、2年、5年、10年生存率分别为:95.4%、82.0%、53.3%、34.1%,农村组分别为94.1%、81.8%、47.4%、26.1%(χ^2=1.506, P =0.220)。城镇组局部控制率分别为92.7%、86.3%、 70.5%、 55.7%,农村组分别为90.2%、80.3%、62.1%、48.4%(χ^2=4.596, P =0.144)。城镇组无远处转移生存率分别为92.9%、87.8%、66.8%、57.0%,农村组分别为88.4%、82.3%、54.3%、 51.1%(χ^2= 5.556, P =0.106)。临床分期、动脉介入治疗、血红蛋白是影响宫颈癌预后的独立因素。结论:与城镇患者比较,农村宫颈癌患者结婚年龄早、发病年龄更轻、婚后罹患宫颈癌时间更早、就诊时病期晚、贫血程度更严重。农村患者生存率、局部控制率及无远处转移生存率均较低,需要通过发展农村经济、卫生,重视宫颈癌筛查,有效扭转农村居民宫颈癌发病率高、病死率高的现状。

Objective: To investigate the differences in the characteristics and treatment prognosis of cervical cancer between urban and rural residents by analyzing clinical data of patients with cervical cancer in Gansu province. Methods: A total of 812 patients with cervical cancer were divided into urban group( n =324) and rural group( n =488) according to the difference of household registration.All patients were treated with a combination of external beam:external irradiation was performed with 8MV-X ray boxed field radiotherapy or three-dimensional conformal radiation therapy),after the dose of 32-44 Gy,the amount of para- uterine tissue was irradiated to the total dose of 46-58 Gy.Cervical brachytherapy was performed with 30-42 Gy(5 to 6 times) during external irradiation period.A total of 151 patients were treated with single uterine artery interventional chemoembolization because of severe vaginal bleeding or a large cervical tumor.A total of 681 patients were treated with radiotherapy were treated with systemic chemotherapy. Results: The survival rates of 1,2,5,and 10 years in urban group were 95.4%,82.0%,53.3%,34.1%,and rural group were 94.1%, 81.8%,47.4%,and 26.1%,respectively(χ^2=1.506, P =0.220).The pelvic control rates in urban group were 92.7%,86.3%,70.5%,55.7%,and rural group were 90.2%,80.3%,62.1%,48.4% respectively (χ^2=4.596, P =0.144).The survival rates without distant metastasis in urban group were 92.9%,87.8%,66.8%,57.0%,and rural group were 88.4%,82.3%,54.3%,and 51.1% respectively (χ^2=5.556, P =0.106).Clinical staging,arterial interventional therapy and hemoglobin were independent factors affecting the prognosis of cervical cancer. Conclusion: Rural patients with cervical cancer have early marriage age,milder onset age,earlyer cervical cancer time after marriage,late onset at the time of treatment,and more severe anemia. Compared with urban patients,the survival rate,pelvic control rate and long-distance metastasis survival rate of rural patients are lower.Through the development of rural economy,health,and attention to cervical cancer screening,it can effectively reverse the current situation of high incidence and high mortality in rural residents.