早期宫颈癌术后联合不同放疗模式的疗效与预后因素分析

Analysis of curative effect and prognostic factors combined with different radiotherapy modes after early cervical cancer surgery

目的 研究早期宫颈癌术后联合应用不同放疗模式的疗效和相关的毒性反应,并探讨其预后的影响因素。方法 回顾性收集175例经术后病理确诊且符合入组条件的ⅠB~ⅡA期宫颈癌患者的临床资料,根据不同的放疗模式分为常规放疗(CRT)组85例和图像引导调强放疗(IGRT)组90例,比较2组的疗效和并发症情况及预后影响因素。结果 CRT组5年生存率和无瘤生存率分别为81.2%和78.4%;IGRT组5年生存率和无瘤生存率分别为94.3%和89.7%,2组间比较差异具有统计学意义(P<0.05)。CRT组和IGRT组的早期、晚期并发症比较,差异均具有统计学意义(P<0.05)。单因素分析显示,淋巴结转移、宫旁组织浸润及阳性切缘为影响早期宫颈癌术后预后的危险因素(P<0.05)。多因素分析显示,影响早期宫颈癌术后预后的独立危险因素是淋巴结转移和宫旁组织浸润(RR=2.449、6.336,P<0.05)。结论 早期宫颈癌术后放疗者,IGRT比CRT明显提高了患者的生存率及无瘤生存率,降低了早、晚并发症的发生率。淋巴结转移和宫旁组织浸润是影响早期宫颈癌术后预后的独立危险因素。

Objective To study the curative effect and related toxicity of the combined application of different radiotherapy techniques in early cervical cancer surgery, and to explore the prognostic factors of patients with cervical cancer surgery.Methods The clinical data of 175 patients with stageⅠB to ⅡA cervical cancer who were diagnosed pathologically were collected retrospectively and met the enrollment conditions. After being subjected to different postoperative radiotherapy techniques, the efficacy and complications of the techniques were assessed for patients, including 85 cases of conventional radiotherapy(CRT) and 90 cases of image guided radiotherapy(IGRT).Results The 5-year survival rate and tumor-free survival rate of the CRT group were 81.2% and 78.4%,respectively;the 5-year survival rate and tumor-free survival rate of the IGRT group were 94.3% and 89.7%. The difference between the two groups was statistically significant(P<0.05). The comparison of early and late complications between CRT group and IGRT group was statistically significant(P<0.05). Univariate analysis showed that lymph node metastasis, parauterine tissue infiltration and positive resection margins were risk factors affecting the prognosis of early cervical cancer after surgery(P<0.05). Multivariate analysis showed that the independent risk factors affecting the prognosis of early cervical cancer were lymph node metastasis and parauterine tissue infiltration(RR= 2.449,6.336,P<0.05).Conclusion Radiation therapy is significant in patients with early cervical cancer surgery. Compared with CRT,IGRT significantly improves the survival rate and tumor-free survival rate of patients, reduces the incidence of early and late complications. Lymph node metastasis and parauterine tissue infiltration are independent risk factors that affect the prognosis of early cervical cancer surgery.