阴道消除量联合放化疗对巨块型ⅢB期宫颈鳞癌的疗效分析

Analysis of vaginal elimination combined with radiotherapy and chemotherapy for giant stage ⅢB cervical squamous cell carcinoma

目的:观察阴道消除量在巨块型ⅢB期宫颈鳞癌治疗中的有效性及安全性。方法:回顾性分析2016年1月至2017年6月49例于重庆大学附属肿瘤医院收治的巨块型ⅢB期宫颈鳞癌患者的临床资料,行阴道消除量+同步放化疗,采用Kaplan-Meier法进行生存分析,采用Cox比例风险回归模型进行预后多因素分析。结果:中位随访时间为36.0个月,完全缓解率为83.7%(41/49),局部复发率为4.1%(2/49),远处转移率为34.7%(17/49)。3年总生存(overall survival,OS)率为76.6%、无病生存(disease free survival,DFS)率为26.7%、无远处转移生存(distant metastais free survival,DMFS)率为26.7%、局部控制率(local control rate,LCR)为77.8%。出现的3~4级急性期不良反应中骨髓抑制占40.82%(20/49)、腹泻占20.41%(10/49)、尿频占6.12%(3/49);出现的3~4级晚期不良反应中放射直肠炎占20.41%(10/49)、膀胱炎占8.16%(4/49)。多因素分析采用Cox比例风险回归模型显示放疗时程影响OS、LCR(P<0.05),A点EQD2剂量影响DMFS、LCR(P<0.05),同步放化疗后鳞状细胞癌相关抗原SCC未转阴者复发率为61%(11/18)。结论:巨块型ⅢB期宫颈鳞癌患者在阴道消除量联合放化疗中生存获益,但直肠、膀胱的不良反应增加,建议个体化治疗。放疗时程是宫颈癌预后的独立因素,SCC可用于宫颈癌随访及监测复发。

Objective:To assess the efficacy and safety of vaginal elimination in the treatment of giant stage IIIB cervical squamous cell carcinoma(SCC).Methods:From January 2016 to June 2017,clinical data of 49 patients with giant stage IIIB cervical SCC in Chongqing University Cancer Hospital were retrospectively analyzed.Survival and influencing factors were analyzed using the Kaplan-Meier method and multivariable Cox model.Results:After a median 36.0-month follow-up,the complete remission,local recurrence,and distant metastasis rates were 83.7%(41/49),4.1%(2/49),and 34.7%(17/49),respectively.The overall survival(OS)rate,disease-free survival rate,distant metastasis-free survival(DMFS)rate,and local control rate(LCR)were 76.6%,26.7%,26.7%,and 77.8%,respectively.The occurrence rates of acute grade 3-4 adverse hematological events,diarrhea,frequency of urination,late grades 3-4 adverse rectitis events,and cystitis were 40.82%(20/49),20.41%(10/49),6.12%(3/49),20.41%(10/49),and 8.16%(4/49),respectively.Cox analysis showed that the duration of radiotherapy affected OS and LCR(P<0.05),the dose of EQD2 affected DMFS and LCR(P<0.05),and the recurrence rate of SCC that persisted despite concurrent radiotherapy and chemotherapy was 61%(11/18).Conclusions:Patients with giant stage IIIB cervical SCC benefit from vaginal elimination combined with radiotherapy and chemotherapy;however,adverse reactions in the rectum and bladder increase,and thus,individualized treatment is recommended.The duration of radiotherapy is an independent factor for the prognosis of cervical cancer.SCC can be used for follow-up and monitoring cervical cancer recurrence.