ⅠB2和ⅡA2期宫颈癌复发的临床分析

Clinical Analysis of The Recurrence of Stage Ⅰ B2 and ⅡA2 Cervical Cancer

目的分析I B2和IIA2期宫颈癌复发和(或)转移的危险因素,探讨术前行新辅助化疗和(或)腔内放疗对复发和(或)转移率的影响。方法回顾性分析251例ⅠB2及ⅡA2期宫颈癌患者的临床资料,分析其年龄、临床分期、肿瘤大小、分化程度、治疗方案、术后病理危险因素、复发时间及生存状态。结果共有63例患者出现复发和(或)转移,淋巴转移、脉管间隙受侵、肿瘤大小、术后病理危险因素个数与复发和(或)转移有关(P<0.05)。其中淋巴结转移是影响复发和(或)转移的主要因素(OR=8.575).直接行根治性手术(RH组)患者、术前行腔内放疗(RTH组)患者、术前行以钳类为基础的新辅助化疗(NACT组)患者、行根治性放疗/放化疗(RT/CRT组)患者发生复发和(或)转移的比例分别为29.6%、22.6%、20.0%、30.2%,差异无统计学意义(P>0.05)。化疗后肿瘤无明显缩小的患者出现复发和(或)转移的比例较化疗后有效的患者明显增高(P<0.05)。结论淋巴转移、脉管间隙受侵、肿瘤大小、术后病理危险因素个数与Ⅰ B2及ⅡA2期期宫癌的复发和(或)转移有关。术前腔内放疗、术前新辅助化疗、术前化疗联合腔内放疗未能减少患者复发和(或)转移的发生,对新辅助化疗敏感的患者复发和(或)转移的发生率低。

Objective To analyze the risk factors of recurrence and/or metastasis of stage Ⅰ B2 and ⅡA2 cervical cancer,and to explore the effect of preoperative neoadjuvant chemotherapy and/or intracavitary radiotherapy on the recurrence and/or metastasis rate.Methods The clinical data of 251 patients with stage Ⅰ B2 and ⅡA2 cervical cancer were retrospectively analyzed.The age,clinical stage,tumor size,differentiation degree,treatment plan,postoperative pathological risk factors,recurrence time and survival status were analyzed.Results A total of 63 patients had recurrence and/or metastasis.Lymphatic metastasis,vascular space invasion,tumor size and the number of postoperative pathological risk factors were related to recurrence and/or metastasis(P<0.05).Lymph node metastasis was the main factor affecting recurrence and metastasis(OR=8.575).The rates of recurrence and/or metastasis were 29.6%,22.6%,20.0%and 30.2%in(RH group),(RTH group),platinum-based neoadjuvant chemotherapy(NACT group)and(RT/CRT group)respectively.There was no significant difFerence(P>0.05).The proportion of recurrence and/or metastasis in patients without significant tumor shrinkage after chemotherapy was significantly higher than that in patients with effective chemotherapy(P<0.05).Conclusion lymphatic metastasis,vascular space invasion,tumor size,and the number of postoperative pathological risk factors are related to the recurrence and/or metastasis of stage Ⅰ B2 and Ⅱ A2 uterine cancer.Preoperative intracavitary radiotherapy,preoperative neoadjuvant chemotherapy,preoperative chemotherapy combined with intracavitary radiotherapy failed to reduce the incidence of recurrence and/or metastasis in patients,and the incidence of recurrence and/or metastasis in patients sensitive to neoadjuvant chemotherapy was low.