早期宫颈癌术后不同治疗方法的治疗效果分析

The value of different therapeutic methods for postoperative treatment of early cervical cancer

目的评估放疗在存在≥2个中危因素的早期宫颈癌术后的重要性,初步探讨早期宫颈癌放疗对血清T淋巴细胞亚群的影响。方法回顾分析2015-01-01-2018-12-30山东大学附属威海市立医院收治的64例包含≥2个中危因素宫颈癌术后患者的病例资料。分为术后观察组(7例)、术后单纯化疗组(7例)、术后单纯放疗组(14例)及术后放化疗组(36例)。放疗方案采用外照射剂量DT50 Gy/25次,内照射F点剂量DT12~18 Gy/2~3次。化疗方案采用多西他赛75 mg/m^(2)+顺铂75 mg/m^(2),21 d/周期,共4个周期。流式细胞仪检测放疗前后血清T淋巴细胞亚群值。采用Kaplan-Meier法计算生存率、Log-rank检验单因素预后分析、χ^(2)检验法分析不良反应的发生情况、t检验法计算放疗前后血清T淋巴细胞亚群值的变化。结果早期宫颈癌术后5年总生存率(OS)为100%,5年无进展生存期(PFS)为83.94%。术后单纯放疗组和术后放化疗组较术后单纯化疗组和单纯手术组均可延长患者5年PFS,差异有统计学意义,χ^(2)=16.317,P<0.001。单因素分析结果显示,肿瘤最大直径>4 cm是影响PFS的因素,χ^(2)=4.579,P=0.032。宫颈癌术后残端复发为最常见复发部位。宫颈癌术后放化疗组增加严重急性胃肠道反应,差异有统计学意义,P=0.005。早期宫颈癌术后放疗使辅助/诱导T细胞绝对计数呈现下降趋势,差异有统计学意义,t=3.875,P=0.004。结论放疗在存在≥2个中危因素的早期宫颈癌术后的重要性。肿瘤最大直径>4 cm是影响PFS的因素。宫颈癌术后放化疗组增加严重急性胃肠道反应,但降低了复发率。早期宫颈癌术后放疗使辅助/诱导T细胞绝对计数呈现下降趋势,意味着机体免疫功能下降。

Objective To evaluate the importance of postoperative radiotherapy in early cervical cancer with ≥2 intermediate-risk factors, and to explore the effect of radiotherapy on serum T lymphocyte subsets in early cervical cancer.Methods The clinical data of 64 patients with cervical cancer who presented ≥2 intermediate-risk factors admitted to Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University from January 1,2015 to December 30,2018 were retrospectively analyzed.The patients were divided into postoperative observation group(n=7),postoperative chemotherapy group(n=7),postoperative radiotherapy group(n=14) and postoperative chemoradiotherapy group(n=36).Radiotherapy scheme: External radiation dose D_T 50 Gy/25 f, internal radiation F point dose D_(T) 12-18 Gy/2-3 f.The chemotherapy regimen was docetaxel 75 mg/m^(2)+cisplatin 75 mg/m^(2),21 days/cycle for 4 cycles.The values of serum T lymphocyte subsets before and after radiotherapy were detected by flow cytometry.The Kaplan-Meier method was used to calculate the survival rate, the Log-rank test was used for univariate prognostic analysis, the χ^(2) test was used to analyze the occurrence of adverse reactions, and the t test was used to calculate the changes in serum T lymphocyte subsets before and after radiotherapy.Results The 5-year overall survival(OS) and progression-free survival(PFS) of early-stage cervical cancer were 100% and 83.94%,respectively.The 5-year PFS of the postoperative radiotherapy group and the postoperative chemoradiotherapy group was longer than that of the postoperative chemotherapy group and the postoperative observation group(χ^(2)=16.317,P<0.001).Single factor analysis showed that the maximum tumor diameter4cm was an influencing factor of PFS(χ^(2)=4.579,P=0.032).Postoperative recurrence of stump for cervical cancer was the most common site of recurrence.There was a statistically significant increase in severe acute gastrointestinal reactions in the postoperative chemoradiotherapy group for cervical cancer(P=0.005).Postoperative radiotherapy for early cervical cancer showed a downward trend in the absolute count of adjuvanted/induced T cells,with a statistically significant difference(t=3.875,P=0.004).Conclusions The importance of radiotherapy in the early stage of cervical cancer after surgery with≥2intermediate risk factors.The maximum tumor diameter>4cm was an independent prognostic factor for PFS.The chemoradiotherapy group after cervical cancer increased severe acute gastrointestinal reactions but reduced recurrence rates.Postoperative radiotherapy for early cervical cancer has shown a downward trend in the absolute count of adjuvant/induced T cells,which means that the body's immune function reduces.