80例ⅣB期血道转移宫颈鳞癌预后分析

Prognostic analysis of patients withⅣB stage hematogenous metastatic cervical squamous cell carcinoma

目的评估ⅣB期血道转移宫颈鳞癌的预后因素及盆腔根治性放疗的价值。方法回顾性分析2006—2016年间在浙江省肿瘤医院接受治疗的ⅣB期血道转移宫颈鳞癌患者80例,并收集相关临床资料。采用Kaplan-Meier生存分析及Cox模型预后因素分析。结果全组患者1、2、5年总生存(OS)率和无进展生存((PFS)率分别为52.5%、26.3%、16.8%和25%、13.8%、8.8%,中位OS和PFS期分别为13.0和5.6个月。最常见转移部位为骨(51.3%),其次为肺(36.3%)和肝(26.3%)。单因素生存分析显示化疗联合盆腔根治性治疗、化疗≥6个周期与OS及PFS呈正相关,而ECOG体能状态评分3~4分、肝转移与OS及PFS呈负相关。多因素分析显示肝转移(HR=2.23,95%CI为1.01~4.91,P=0.048)及体能状态评分3~4(HR=2.01,95%CI为1.03~3.91,P=0.040)为OS不利因素。亚组多因素分析显示化疗+盆腔根治性放疗比化疗±姑息放疗能改善患者OS(HR=0.39,95%CI为0.18~0.84,P=0.016),接受≥4个周期比<4个周期双药联合化疗能改善患者OS(HR=0.32,95%CI为0.15~0.68,P=0.003)。结论体能状态不佳及肝转移患者预后不佳。在化疗基础上联合盆腔根治性放疗可改善ⅣB期血道转移宫颈癌患者的预后。

Objective To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stageⅣB hematogenous metastatic cervical squamous cell carcinoma.Methods Clinical data of 80 patients withⅣB stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed.The survival analysis was conducted by Kaplan-Meier method.Prognostic factors were analyzed by Cox models.Results The 1-,2-and 5-year overall survival(OS)and progression-free survival(PFS)rates were 52.5%,26.3%,16.8%and 25%,13.8%,8.8%,with a median OS of 13.8 months and a median PFS of 5.6 months,respectively.The most common site of metastasis was bone(51.3%),followed by lung(36.3%)and liver(26.3%).Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and≥6 cycles of chemotherapy were positively correlated with OS and PFS,whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS.In multivariate analysis,liver metastasis(HR=2.23,95%CI:1.01-4.91,P=0.048)and ECOG performance status score of 3-4(HR=2.01,95%CI:1.03-3.91,P=00.040)were significantly correlated with poor OS.Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy,systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS(HR=0.39,95%CI:0.18-0.84,P=0.016).Compared with double drugs combined with<4 cycles of chemotherapy,double drugs in combination with≥4 cycles of chemotherapy significantly improved OS(HR=0.32,95%CI:0.15-0.68,P=0.003).Conclusions Patients with low ECOG performance status score or liver metastasis obtain poor prognosis.Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients withⅣB stage hematogenous metastatic cervical squamous cell carcinoma.