晚期子宫内膜癌术后不同辅助治疗方式的生存预后分析

Survival analysis of different adjuvant treatments for postoperative patients with advanced endometrial cancer

目的探讨晚期子宫内膜癌术后不同辅助治疗方式对患者生存预后的影响。方法收集2012年1月至2019年1月郑州大学第一附属医院收治的Ⅲ~Ⅳ期子宫内膜癌患者237例,根据术后辅助治疗方式不同分为单纯化疗组(107例)、化疗-放疗组(55例)、化疗-放疗-化疗组(75例),比较3组患者的不良反应发生率、复发及生存情况。结果单纯化疗组、化疗-放疗组、化疗-放疗-化疗组患者的中位PFS分别为31个月(95%CI为27.10~34.90)、39个月(95%CI为31.07~46.93)、48个月(95%CI为25.90~70.10),中位OS分别为56个月(95%CI为53.70~58.30)、59个月(95%CI为54.10~63.90)、78个月(95%CI为68.60~87.40)。化疗-放疗-化疗组患者的PFS及OS均显著优于单纯化疗组与化疗-放疗组患者(P<0.05)。3组的3年无进展生存率分别为40.10%、50.90%和62.40%,差异均有统计学意义(P<0.05)。3组的严重不良反应发生率分别为16.80%、23.60%和24.00%,差异无统计学意义(P>0.05)。多因素分析显示,术后行化疗-放疗-化疗治疗模式是延长患者PFS及OS的独立保护因素。对影响患者预后的相关因素进行调整后,单纯化疗组患者肿瘤进展风险比值为化疗-放疗-化疗组患者的1.79倍(95%CI为1.21~2.65,P<0.05),死亡风险比为其2.06倍(95%CI为1.01~2.47,P<0.05);化疗-放疗组患者肿瘤进展风险比值为化疗-放疗-化疗组患者的1.58倍(95%CI为1.34~3.23,P<0.05),死亡风险比为其1.74倍(95%CI为1.02~2.97,P<0.05)。结论晚期子宫内膜癌患者术后进行化疗-放疗-化疗式疗法可延长无进展生存期及总生存期,未明显增加严重不良反应发生率。

Objective:To evaluate the effects of different adjuvant treatment methods on advanced endometrial cancer patients'survival and recurrence.Methods:A retrospective analysis of 237 patients with International Federation of Gynecology and Obstetrics(FIGO)stagesⅢandⅣendometrial cancer from January 2012 to January 2019 was conducted in the First Affiliated Hospital of Zhengzhou University.According to different postoperative adjuvant treatment modes,the patients were divided into single chemotherapy group(107 cases),chemotherapy-radiotherapy group(55 cases),chemotherapy-radiotherapy-chemotherapy group(75 cases).The recurrence and survival of the three groups were compared,and the side effects of patients were analyzed as wells.Results:The median progression-free survivals(PFS)of the patients with single chemotherapy group,chemotherapy-radiotherapy group,chemotherapy-radiotherapy-chemotherapy group were 31(95%CI:27.10~34.90)months,39(95%CI:31.07~46.93)months,48(95%CI:25.90~70.10)months,respectively.The median overall survival(OS)of the patients with single chemotherapy group,chemotherapy-radiotherapy group,chemotherapy-radiotherapy-chemotherapy group were 56(95%CI:53.70~58.30)months,59(95%CI:54.10~63.90)months,78(95%CI:68.60~87.40)months,respectively.The PFS and OS of chemotherapy-radiotherapy-chemotherapy were significantly longer than single chemotherapy group,chemotherapy-radiotherapy group(P<0.05).The 3-year PFS rate were 40.10%,50.90%and 62.40%,respectively,and the differences among the three groups were statistically significant(P<0.05).There was no difference in the frequency of adverse effects(16.80%,23.60%,24.00%)among the three groups.After adjusted these risk effects,the tumor progression hazard ratio(HR)was 1.79(95%CI:1.21~2.65,P<0.05)for the single chemotherapy group and 1.58(95%CI:1.34~3.23,P<0.05)for the chemotherapy-radiotherapy group,compared to the chemotherapy-radiotherapy-chemotherapy group.The death hazard ratio was 2.06(95%CI:1.01~2.47,P<0.05)for the single chemotherapy group and 1.74(95%CI:1.02~2.97,P<0.05)for the chemotherapy-radiotherapy group,compared to the chemotherapy-radiotherapy-chemotherapy group.Conclusion:Sequential chemotherapy-radiotherapy-chemotherapy was associated with improved survival in women with advanced stage disease compared to other sequencing modalities with a similar adverse effect profile.