宫颈癌术后中危患者放疗与同步放化疗的疗效分析

Analysis of clinical efficacy of radiotherapy alone and concurrent chemoradiotherapy in cervical cancer patients with intermediate risk factors after surgery

目的分析早期(ⅠB-ⅡA期)宫颈癌术后存在中危因素患者同步放化疗与单纯放疗后生存情况、失败模式、急性不良反应及预后因素。方法回顾性分析2016年1月至2018年12月宁夏医科大学总医院放疗科收治的早期宫颈癌术后存在中危因素的患者211例,单纯放疗(RT)组91例,同步放化疗(CCRT)组120例。卡方检验对比两组患者3、5年的总生存(OS)率和无进展生存(PFS)率、失败模式及急性不良反应的差异。采用Kaplan-Meier法进行OS及PFS的单因素分析,并进行log-rank检验;用Cox模型进行多因素预后分析。结果211例患者3、5年的OS率分别为95.0%、93.8%,PFS率分别为86.8%、83.2%。CCRT组和RT组患者的OS率分别为93.9%、96.5%(3年)、91.8%、96.5%(5年)(χ2=1.763,P=0.184),PFS率分别为84.4%、89.9%(3年)、79.3%、88.3%(5年)(χ2=2.619,P=0.106),两组均无差异。两组患者总复发率为15.64%,两组患者复发率、局部和远处失败模式的差异均无统计学意义(χ2=2.623,P=0.105;χ2=6.745,P=0.080),主要失败模式为局部区域复发及肺转移。多因素分析显示病理类型可能是OS的影响因素(χ2=3.849,P=0.05),侵犯深度是PFS的独立预后因素(χ2=4.095,P=0.043)。CCRT组急性胃肠道反应及骨髓抑制显著高于RT组(χ2=56.425、27.833,P值均<0.001)。结论早期宫颈癌术后存在中危因素的患者辅助放疗疗效好,主要失败模式为局部区域复发及肺转移。病理类型可能是OS的独立预后因素,侵犯深度是PFS的独立预后因素。同步放化疗较单纯放疗增加了急性胃肠道不良反应及骨髓抑制,但可耐受。单纯放疗和同步放化疗疗效无显著差异,需要进一步扩大样本量进行研究。

Objective To retrospectively analyze the differences of survival,recurrence,acute side effects and prognostic factors between early stage(stageⅠB‐ⅡA)cervical cancer patients with intermediate risk factors receiving postoperative concurrent chemoradiotherapy(CCRT)or radiotherapy(RT)alone.Methods Clinical data of 211 patients with intermediate risk factors after early stage cervical cancer surgery admitted to Department of Radiation Oncology of General Hospital of Ningxia Medical University from January 2016 to December 2018,were retrospectively analyzed.Among them,91 cases were assigned in the RT group and 120 cases in CCRT group.The 3‐and 5‐year overall survival(OS),progression‐free survival(PFS),recurrence and acute side effects were compared between two groups by Chi‐square test.Univariate analysis of OS and PFS was performed by Kaplan‐Meier method and log‐rank test was performed.Multivariate prognostic analysis was conducted by using Cox model.Results The 3‐and 5‐year OS of 211 patients were 95.0%and 93.8%,respectively.The 3‐and 5‐year PFS were 86.8%and 83.2%,respectively.The OS of CCRT and RT group were 93.9%,96.5%(3‐year),91.8%,96.5%(5‐year)respectively(χ2=1.763,P=0.184),and the PFS were 84.4%,89.9%(3‐year),79.3%,88.3%(5‐year)(χ2=2.619,P=0.106),with no difference between the two groups.The total recurrence rate was 15.64%,and there was no significant difference in the recurrence rate and recurrence area between two groups(χ2=2.623,P=0.105;χ2=6.745,P=0.080).Locoregional recurrence and lung metastasis were the main patterns of failure.Multivariate prognostic analysis showed that pathological type might significantly affect the OS(χ2=3.849,P=0.05),and depth of invasion significantly affected the PFS(χ2=4.095,P=0.043).The incidence of acute gastrointestinal side effect and bone marrow suppression in the CCRT group was significantly higher than that in the RT group(χ2=56.425,27.833;both P<0.001).Conclusions Patients with intermediate risk factors after early cervical cancer surgery obtain high efficacy after radiotherapy.The main patterns of failure are locoregional recurrence and lung metastasis.The pathological type may be an independent prognostic factor of OS and the depth of invasion is an independent prognostic factor of PFS.Compared with RT,CCRT increases the risk of acute gastrointestinal side effects and myelosuppression,which can be tolerated.There is no significant difference in the clinical efficacy between RT and CCRT,which remains to be validated by large sample size studies.