Ⅰ-Ⅱ期子宫内膜癌术后辅助治疗疗效评价及预后因素分析

Evaluation of adjuvant therapy for stageⅠ-Ⅱendometrial cancer and analysis of prognostic factors

目的:探讨Ⅰ-Ⅱ期子宫内膜癌术后不同辅助治疗方式对患者生存和预后的价值,并综合分析其中影响预后因素。方法:对符合纳入标准并在我院妇科中心治疗的Ⅰ-Ⅱ期子宫内膜癌患者随访资料、病理结果以及临床数据进行回顾性分析,对影响患者术后生存结局和预后因素分别进行Kaplan-Meier生存分析和多因素Logistic回归模型分析;卡方检验分析复发率及生存率。有统计学差异用P<0.05表示。结果:本研究共纳入143例患者,其中术后化疗者58例、放疗者19例、联合放化疗者66例,中位随访时间59个月,生存时间为24~144个月,3年及5年生存率化疗组为92.90%、82.40%,放疗组为93.10%、87.50%,联合放化疗组为98.10%、88.30%,三组数据差异有统计学意义(χ^(2)=6.029,P=0.04)。未复发率化疗组为36%,放疗组为14%,放化疗组为50%,差异有统计学意义(χ^(2)=9.385,P=0.01)。χ^(2)检验结果表明:患者年龄、是否复发、组织学分级及类型与术后辅助治疗疗效差异有统计学意义(P<0.05)。术后放化疗可能是保护性因素[P<0.05,OR=0.563,95%CI(0.048~6.563)];而术后复发是一项强有力的独立危险因素[P<0.01,OR=42.047,95%CI(21.708~61.121)]。结论:组织学类型、分级,术后辅助治疗方式,复发情况可影响Ⅰ-Ⅱ期子宫内膜癌患者的生存情况,术后联合放化疗能够有效避免疾病再发,改善生存率以及总生存时间。

Objective:To study the remaining alive patients and predictive factors of different methods of adjuvant treatment for patients with stageⅠ-Ⅱendometrial cancer after surgery,and comprehensively evaluate the elements that influence the prognosis.Methods:A retrospective analysis of the follow-up material,pathological results,and clinical data of patients with stageⅠ-Ⅱendometrial cancer who met the inclusion criteria and were treated in the gynecology center of our hospital,to influence the survival outcome and prognosis of the patients.Kaplan-Meier survival analysis and multivariateregression model were used to analyze the factors.The recurrence rate and survival rate were analyzed by chi-square test.Affecting elements of prognosis were evaluated by the multivariate Logistic regression model.P<0.05 means the difference is statistically significant.Results:Among the 143 patients with stageⅠ-Ⅱendometrial cancer,there were 58 cases of postoperative chemotherapy,19 cases of radiotherapy,and 66 cases of combined radiotherapy and chemotherapy.The median follow-up time was 59 months,and the remaining alive time was 24~144 months.The 3-year and 5-year survival rates of chemotherapy group,radiotherapy group,and combined radiotherapy and chemotherapy group were 92.90%and 82.40%,93.10%,and 87.50%,98.10%and 88.30%,respectively,(χ^(2)=6.029,P=0.04).The non-recurrence rate was 36%in the chemotherapy group,14%in the radiotherapy group,and 50%in the combined radiotherapy and chemotherapy group.The difference was statistically significant(χ^(2)=9.385,P=0.01).The results of theχ^(2)the test showed that:the patient's age,recurrence,histological grade and type,and postoperative adjuvant treatment efficacy were significantly different(P<0.05).In postoperative adjuvant therapy,chemoradiotherapy may be a protective factor[P<0.05,OR=0.563,95%CI(0.048~6.563)],while postoperative recurrence is a strong independent risk factor[P<0.01,OR=42.047,95%CI(21.708~61.121)].Conclusion:Thehistological type,grading,postoperative adjuvant therapy,and recurrence can affect the survival of patients with stageⅠ-Ⅱendometrial cancer.Postoperative radiotherapy combined with chemotherapy can effectively avoid disease recurrence,improve survival rate and overall survival time.