宫颈癌根治性放疗期间肿瘤退缩率对患者预后的影响

Prognostic implications of tumor regression rate during radical radiotherapy in patients with cervical cancer

目的探讨宫颈癌根治性放疗期间肿瘤退缩率(tumor regression rate,TRR)对患者预后的影响。方法选择接受根治性放疗±同期顺铂化疗的初诊ⅠB1-ⅣA期宫颈癌患者。外照射开始后第4~5周行三维后装放疗。基线及第1次后装放疗前均行盆腔磁共振(MRI)检查,肿瘤大小采用盆腔MRI三维肿瘤最大单径表示。TRR=(基线肿瘤大小-后装前肿瘤大小)/基线肿瘤大小×100%,TRR≥75%与TRR<75%分组进行比较。结果共分析107例患者,中位随访时间27.6个月(3.0~59.0个月)。鳞癌94.4%,FIGOⅢA~ⅣA期72.0%,同期化疗患者比例85.0%。基线及后装前肿瘤大小分别为(5.0±1.8)cm,(2.4±1.7)cm;TRR为(51.3±34.0)%。TRR≥75%患者的2年局部控制率(LCR)(100%vs 80.9%,P=0.018)及2年总生存率(OS)(96.0%vs 77.6%,P=0.012)均高于TRR<75%的患者。COX分析显示TRR(P=0.005,HR=0.972,95%CI 0.953~0.991)及基线肿瘤大小(P=0.007,HR=1.460,95%CI 1.109~1.922)与LCR相关;TRR(P=0.031,HR=0.981,95%CI 0.964~0.998)及基线肿瘤大小(P=0.027,HR=1.416,95%CI 1.041~1.926)与OS相关。基线血小板/淋巴细胞比值(PLR)及放疗后体重减轻百分比与TRR≥75%相关。结论宫颈癌根治性放疗期间的TRR与肿瘤的LCR及OS相关,第4~5周时TRR<75%的患者具有更高的局部失败和死亡风险。

Objective To study the prognostic effects of tumor regression rate(TRR)during radical(chemo)radiotherapy for cervical cancer.Methods Patients with FIGO IB1-IVA cervical cancer from January 2015 through September 2019 were retrospectively analyzed.All patients were treated with radical(chemo)radiotherapy and had available baseline and pre-brachytherapy(BT)pelvic MRI.Brachytherapy was first performed at 4 to 5-week from the start of radiotherapy.Tumor size was defined as the largest single diameter measured three-dimensionally on MRI.TRR=(baseline tumor size-pre-BT tumor size)/baseline tumor size×100%.Results A total of 107 patients were eligible.Median follow-up was 27.6 months(range 3.0~59.0).Squamous cell carcinoma accounted for 94.4%.FIGO(2018)ⅢA-ⅣA accounted for 72.0%.Eighty-five percent patients received concurrent chemotherapy.Baseline and pre-BT tumor sizes were(5.0±1.8)cm and(2.4±1.7)cm,respectively.TRR was(51.3±34.0)%.Compared with TRR<75%,patients with TRR≥75%had significantly higher 2-year local control rate(LCR)(100%vs.80.9%,P=0.018)and 2-year overall survival(OS)rate(96.0%vs.77.6%,P=0.012).COX analysis showed that TRR(P=0.005,HR=0.972,95%CI:0.953-0.991)and baseline tumor size(P=0.007,HR=1.460,95%CI:1.109-1.922)were associated with LCR;TRR(P=0.031,HR=0.981,95%CI:0.964-0.998)and baseline tumor size(P=0.027,HR=1.416,95%CI:1.041-1.926)were associated with OS.Baseline platelet-to-lymphocyte ratio(PLR)and the percentage of weight loss after radiotherapy were correlated with TRR≥75%.Conclusion The TRR during radical(chemo)radiotherapy for cervical cancer is correlated to LCR and OS.Patients with TRR<75%at the 4^(th) to 5^(th) week have higher risks of local failure and death.