新辅助化疗后行根治术的ⅡB期宫颈癌患者的生存结局及危险因素分析

Survival outcomes and risk factors of patients with stage Ⅱ B cervical cancer undergoing neoadjuvant chemotherapy followed by radical hysterectomy

目的探讨新辅助化疗(neoadjuvant chemotherapy,NACT)后行腹腔镜宫颈癌根治术的ⅡB期宫颈癌患者的生存结局及其危险因素。方法收集2015~2018年于陆军军医大学第一附属医院妇产科接受NACT后行腹腔镜根治性子宫切除术的178例ⅡB期宫颈癌患者资料。采用回顾性队列研究,针对手术病理特征进行COX回归分析,并根据其结果进行分层分析,通过Kaplan-Meier生存曲线和log-Rank检验方法分析不同亚组人群的生存结局。结果本研究共纳入了178例患者,中位随访时间为51个月。3年无复发生存率(disease free disease,DFS)、总生存率(overall survival,OS)分别为75.4%和82.6%。COX回归分析提示,淋巴结转移(HR:2.04,95%CI:1.16~3.60)和深肌层浸润(HR:4.72,95%CI:2.11~10.60)是DFS的独立风险因素;淋巴结转移(HR:2.77,95%CI:1.48~5.22)、深肌层浸润(HR:4.24,95%CI:1.64~10.98)和NACT后肿瘤直径≥4 cm(HR:2.12,95%CI:1.14~3.94)是OS的独立风险因素。有或无淋巴结转移患者3年DFS分别为55.3%和81.0%(P<0.001),3年OS分别为64.8%和87.7%(P<0.001)。有或无深肌层浸润患者3年DFS分别为64.1%和92.8%(P<0.001),3年OS分别为73.2%和95.7%(P<0.001)。NACT后肿瘤直径<4 cm和肿瘤直径≥4 cm患者比较,3年DFS无统计学差异,而3年OS分别为85.1%和74.4%(P=0.028)。NACT后肿瘤直径缩小>50%患者的DFS和OS明显优于肿瘤直径缩小≤50%的患者,3年DFS分别为92.9%和71.0%(P<0.001),3年OS分别为93.0%和82.4%(P=0.017)。结论NACT后肿瘤直径缩小>50%的ⅡB期宫颈癌患者术后有更佳的生存结局;淋巴结转移、深肌层浸润和NACT后肿瘤直径≥4 cm是ⅡB期宫颈癌预后的独立危险因素。

Objective To investigate the survival outcomes and risk factors of patients with stageⅡB cervical cancer undergoing neoadjuvant chemotherapy(NACT)followed by laparoscopic radical hysterectomy(LRH).Methods A retrospective cohort study was conducted on 178 patients with stageⅡB cervical cancer who underwent NACT followed by LRH in our department from 2015 to 2018.COX regression analysis was used to analyze the surgical pathological characteristics,and stratified analysis was performed according to the results.Kaplan-Meier survival curve analysis and log-Rank test were employed to analyze the survival outcomes of different subgroups.Results For the 178 subjected patients,their median follow-up period was 51 months,and the rates of 3-year disease-free survival(DFS)and overall survival(OS)were 75.4%and 82.6%,respectively.COX regression analysis showed that lymph node metastasis(LNM)(HR:2.04,95%CI:1.16~3.60)and deep stromal invasion(DSI)(HR:4.72,95%CI:2.11~10.60)were independent risk factors for DFS.LNM(HR:2.77,95%CI:1.48~5.22),DSI(HR:4.24,95%CI:1.64~10.98)and tumor diameter≥4 cm after NACT(HR:2.12,95%CI:1.14~3.94)were independent risk factors for OS.The rates of 3-year DFS of patients with and without LNM was 55.3%and 81.0%(P<0.001),and the rates of 3-year OS was 64.8%and 87.7%(P<0.001),respectively.The rates of 3-year DFS of patients with and without DSI were 64.1%and 92.8%(P<0.001),and the rates of 3-year OS were 73.2%and 95.7%(P<0.001),respectively.There was no significant difference in DFS between patients with tumor diameter<4 cm and≥4 cm after NACT,while the rates of 3-year OS was 85.1%and 74.4%,respectively(P=0.028).The DFS and OS of patients with tumor diameter reduction>50%after NACT were significantly better than those≤50%(the 3-year DFS rate:92.9%vs 71.0%,P<0.001;the 3-year OS rate:93.0%vs 82.4%,P=0.017).Conclusion Patients with stageⅡB cervical cancer with tumor diameter reduced by>50%after NACT have better survival outcomes.LNM,DSI and tumor diameter≥4 cm after NACT are independent risk factors for the prognosis of stageⅡB cervical cancer.