不同方案治疗Ⅲ期宫颈癌患者的安全性和预后分析

Safety and prognosis analysis of different regimens in the treatment of patients with stage Ⅲcervical cancer

目的比较不同方式治疗Ⅲ期宫颈癌患者的不良反应和预后。方法采用回顾性分析,将2010年1月至2020年12月苏州大学附属第一医院收治的194例按照国际妇产科联盟2018分期为Ⅲ期宫颈癌患者(ⅢA期16例,ⅢB期23例,ⅢC1期136例,ⅢC2期19例),按治疗方法不同分为根治性放疗±化疗组(81例)和根治术+放疗±化疗组(113例),采用χ^(2)检验比较不良反应的差异。以Kaplan-Meier法绘制生存曲线和无进展生存曲线,并行Log rank检验。进一步对136例ⅢC1期患者进行分析不良反应和预后的差异。结果根治性放疗±化疗组患者更容易发生3、4级血红蛋白下降(χ^(2)=10.68,P=0.004)、直肠黏膜炎(χ^(2)=14.41,P=0.001)以及阴道瘘(χ^(2)=7.16,P=0.012),根治术+放疗±化疗组患者更容易发生天门冬氨酸氨基转移酶(χ^(2)=10.96,P=0.002)和丙氨酸氨基转移酶(χ^(2)=8.49,P=0.010)升高。根治性放疗±化疗组和根治术+放疗±化疗组患者的5年无进展生存率分别为58.3%和74.5%(χ^(2)=5.33,P=0.021)。在136例ⅢC1期患者中,根治性放疗±化疗组(34例)更容易发生直肠黏膜炎(χ^(2)=13.25,P=0.003),根治术+放疗±化疗组(102例)更容易发生天门冬氨酸氨基转移酶升高(χ^(2)=6.18,P=0.046)。根治性放疗±化疗组和根治术+放疗±化疗组患者的5年生存率分别为85.5%和86.3%(P=0.893),5年无进展生存率分别为65.6%和77.1%(P=0.244)。结论对于Ⅲ期宫颈癌患者,与根治术+放疗±化疗组相比,根治性放疗±化疗组更容易发生进展,预后较差;对于ⅢC1期宫颈癌患者,根治性放疗±化疗组和根治术+放疗±化疗组患者预后无明显差异。2种治疗方式可导致不同的不良反应,无明显优劣。考虑手术所带来的风险和经济负担,更推荐ⅢC1期宫颈癌患者行根治性放化疗。

Objective To compare the toxicity and prognosis of patients with stageⅢcervical cancer treated using different regimens.Methods A retrospective analysis was carried out for 194 patients with stageⅢcervical cancer determined according to the revised 2018 International Federation of Gynecology and Obstetrics staging system(16 cases of stageⅢA,23 cases of stageⅢB,136 cases of stageⅢC1,and 19 cases of stageⅢC2)admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2020.They were divided into a radical radiotherapy±chemotherapy group(81 cases)and a radical hysterectomy+radiotherapy±chemotherapy group(113 cases)according to different treatment method.The difference in toxicity between the two groups was determined using theχ^(2) test.The survival curves and progression-free survival curves were plotted using the Kaplan-Meier method,and the Log rank test was also performed.The differences in toxicity and prognosis were further analyzed in 136 patients with stageⅢC1 cervical cancer result patients in the radical radiotherapy±chemotherapy group were more likely to have hemoglobin decline(χ^(2)=10.68,P=0.004),rectal mucositis(χ^(2)=14.41,P=0.001),and vaginal fistula(χ^(2)=7.16,P=0.012)of grades 3 and 4.Patients in the radical hysterectomy+radiotherapy± chemotherapy group were more likely to have increased aspartate aminotransferase ( χ^(2) =10. 96, P= 0. 002) and alanine aminotransferase (χ^(2) = 8. 49, P= 0. 010). The differences were statisticallysignificant. The 5-year progression-free survival rate of the radical radiotherapy±chemotherapy group was58. 3%, which was lower than that of the radical hysterectomy + radiotherapy ± chemotherapy group(74. 5%;χ^(2) = 5. 33, P= 0. 021). Among the 136 patients with stage ⅢC1cervical cancer, the ones in theradical radiotherapy±chemotherapy group (34 cases) were more likely to develop rectal mucositis ( χ^(2) =13. 25, P= 0. 003), while the ones in the radical hysterectomy + radiotherapy±chemotherapy group (102cases) were more likely to have elevated aspartate aminotransferase ( χ^(2) = 6. 18, P = 0. 046 ). Thedifferences were statistically significant. The 5-year survival rates of the radical radiotherapy±chemotherapygroup and the radical hysterectomy + radiotherapy ± chemotherapy group were 85. 5% and 86. 3%,respectively. The difference was not statistically significant ( P = 0. 893). The 5-year progression-freesurvival rates of the radical radiotherapy±chemotherapy group and the radical hysterectomy + radiotherapy±chemotherapy group were 65. 6% and 77. 1%, respectively. The difference was not statistically significant(P = 0. 244 ). Conclusions For patients with stage Ⅲ cervical cancer, the ones in the radicalradiotherapy±chemotherapy group were more likely to progress and have a poorer prognosis compared withthe ones in the radical hysterectomy+radiotherapy±chemotherapy group. For patients with stage ⅢC1cervicalcancer, there was no significant difference in the prognosis of patients between the groups. The twotreatment method lead to different toxicity, with no obvious advantages and disadvantages. Considering therisks and economic burdens caused by surgery, radical radiotherapy and chemotherapy is recommended forpatients with stage ⅢC1cervical cancer.