局部晚期宫颈癌同步放化疗疗效和预后分析

Efficacy and prognosis analysis of concurrent chemoradiotherapy for patients with locally advanced cervical cancer

目的探讨局部中晚期宫颈癌(LACC)同步放化疗联合近距离治疗的疗效及预后影响因素。方法回顾性分析2015-02-01-2017-03-30于中山大学肿瘤防治中心完成治疗的249例LACC患者的临床资料,观察近远期疗效、慢性放射性不良反应,分析相关预后影响因素。结果符合纳入排除标准的患者共229例,均随访≥2年或死亡截止。近期缓解率为84.3%(193/229)。单因素分析显示,近期疗效与年龄(χ2=4.796)、FIGO分期(χ2=4.142)、组织学类型(χ2=4.120)和治疗前淋巴结转移(χ2=18.047)有关联,均P<0.05;多因素分析显示,腺癌的未缓解率约为鳞癌的3.6倍,OR=3.571,95%CI为1.078~11.822,P=0.037;治疗前淋巴结转移患者的未缓解率是无转移的4.5倍,OR=4.459,95%CI为1.647~12.071,P=0.003。慢性放射性直肠炎(CRP)的发生及严重程度与直肠累积D2cm3有关,无CRP、轻度CRP和重度CRP患者的直肠累积D2cm3分别为69.9、72.2和73.4Gy,F=12.131,P<0.001。2年累积复发率(CIR)和总生存(OS)率分别为22.7%(52/229)和77.3%(177/229)。单因素分析显示,CIR与治疗前SCC-Ag(OR=1.799)、HGB(OR=0.552)、FIGO分期(OR=2.063)、病理类型(OR=2.244)和淋巴结转移(OR=3.391)有关联,均P<0.05;OS与治疗前SCC-Ag水平(HR=2.391)、FIGO分期(HR=2.201)和淋巴结转移(HR=5.676)有关联,均P<0.05。多因素分析显示,治疗前淋巴结转移者的2年CIR是无转移的2.6倍,OR=2.557,95%CI为1.290~5.068,P=0.007,是独立危险因素;前者的2年OS率约为后者的5.5倍,HR=5.514,95%CI为2.504~12.145,P<0.001,是独立危险因素。结论同步放化疗联合近距离治疗LACC的近远期疗效基本满意;为防发生严重CRP,设计放射治疗计划时,应严格限制直肠D2cm3;治疗前淋巴结转移是近远期疗效的独立预后危险因素,对于治疗前淋巴结转移者,应采取更加积极的个体化治疗措施。

Objective To investigate the efficacies and prognostic factors of concurrent chemoradiotherapy(CCRT)combined with brachytherapy(BT)in patients with locally advanced cervical cancer(LACC).Methods The clinical data of 249 patients with LACC who completed CCRT and subsequent brachytherapy in our hospital between February 1st,2015and March 30th,2017were retrospectively analyzed.Short-term and long-term efficacies,chronic radiotoxicity,and prognostic factors were assessed.Results A total of 229patients met the inclusion and exclusion criteria and were followed up for more than 2years or until death.The short-term objective response(OR)rate was 84.3%(193/229).Univariate analysis showed that the short-term efficacy was significantly correlated with age(χ2=4.796),FIGO stage(χ2=4.142),histological type(χ2=4.120)and metastatic lymph nodes(χ2=18.047)before treatment.Multivariate analysis showed that the non-response rate of adenocarcinoma was 3.6times higher than that of squamous cell carcinoma(OR=3.571,95%CI:1.078-11.822,P=0.037).The non-response rate of patients with metastatic lymph nodes before treatment was 4.5 times higher than that of patients without metastasis(OR=4.4591,95%CI:1.647-12.071,P=0.003).The occurrence and severity of chronic radiation proctitis(CRP)were related to the accumulation of D2cm3in rectum.The rectal accumulated D2cm3of patients with no CRP,mild CRP and severe CRP were 69.9,72.2and 73.4Gy,respectively(F=12.131,P<0.001).The 2years,cumulative incidence of overall recurrence(CIR)and overall survival(OS)rate were 22.7%and 77.3%,respectively.Univariate analysis showed that recurrence was significantly correlated with SCC-Ag(OR=1.799)and HGB(OR=0.552)_levels before treatment,FIGO stage(OR=2.063),pathological type(OR=2.244)and metastatic lymph nodes(OR=3.391)before treatment and OS was significantly correlated with SCC-Ag(HR=2.391),FIGO stage(HR=2.201)and metastatic lymph nodes(HR=5.676)before treatment.Multivariate analysis showed that the 2-years CIR of patients with metastatic lymph nodes before treatment which was an independent risk factor was 2.6times higher than that of patients without metastatic lymph nodes(OR=2.557,95%CI:1.290-5.068,P=0.007),and the 2-years OS of the former which was an independent risk factor was about 5.5times that of the latter(HR=5.514,95%CI:2.504-12.145,P<0.001).Conclusions The short-term and long-term efficacies of patients with LACC who accepted CCRT combined with BT are relatively satisfactory;when designing a radiotherapy plan,it is necessary to strictly limit the accumulated D2cm3of the rectum to prevent serious CRP;lymph node metastasis before treatment is an independent prognostic risk factor for the short-term and long-term efficacies.For patients with lymph node metastasis,more active individualized treatment strategies should be adopted.