术后“夹心模式”放化疗治疗Ⅲ期子宫内膜癌的临床疗效

A retrospective analysis of“sandwich”adjuvant chemotherapy and radiotherapy for patients with stageⅢendometrial carcinoma

目的评估术后“夹心模式”放化疗(化疗2~3个周期,放疗后再行2~3个周期化疗)治疗Ⅲ期子宫内膜癌的临床疗效及其影响因素。方法回顾性分析我院收治的子宫内膜癌患者的临床资料,筛选出病理类型为子宫内膜样腺癌或子宫内膜腺鳞癌、临床分期为Ⅲ期、治疗方案为“夹心模式”放化疗的患者93例。比较完成治疗组与未完成治疗组间无复发生存期(DFS)的差异,分析与预后相关的临床因素以及导致治疗终止的原因。结果93例患者中,64例(68.8%)完成既定治疗方案,DFS为1年、3年、5年的患者比例分别为98.44%、84.32%、80.75%;29例(31.2%)未完成既定治疗方案,DFS为1年、3年、5年的患者比例分别为93.10%、72.1%、66.95%。与不良预后相关的临床因素包括病理分级为G_(3)(HR=2.310,P=0.044)和化疗周期数<4(HR=2.585,P=0.018)。导致治疗终止的首要原因为骨髓抑制(48.3%),其他原因包括患者主观因素(31.0%)、心律失常(5.9%)、肝损伤(5.9%)、肾损伤(2.9%)、脑梗死(2.9%)。结论Ⅲ期子宫内膜癌患者术后完成“夹心模式”放化疗方案可获得较好的预后。改进治疗相关不良反应的预防和处理措施,加强患者的教育和管理,是顺利完成治疗的有效保障。

Objective To evaluate the clinical efficacy and factors that influence“sandwich”adjuvant chemotherapy and radiotherapy(2-3 cycles of chemotherapy followed by 2-3 cycles of chemotherapy after radiotherapy)in the treatment of patients with stageⅢendometrial cancer.Methods The clinical data of patients with endometrial cancer who were admitted to our hospital were retrospectively analyzed.A total of 93 patients with endometrioid adenocarcinoma or endometrial adenosquamous carcinoma at stageⅢwho underwent“sandwich”adjuvant chemotherapy and radiotherapy were included.Disease-free survival(DFS)was compared between the complete and incomplete treatent groups.Clinical factors related to prognosis and reasons of treatment termination were analyzed.Results Of the 93 patients,64(68.8%)completed the established treatment regimen,the 1-,3-,and 5-year DFS rates were 98.44%,84.32%,and 80.75%,respectively.Meanwhile,29(31.2%)did not complete the established treatment regimen,and they had 1-,3-,and 5-year DFS rates of 93.10%,72.1%,and 66.95%,respectively.The clinical factors associated with poor prognosis included pathologic grade G_(3)(HR=2.310,P=0.044)and number of chemotherapy cycles<4(HR=2.585,P=0.018).The most common reason for treatment termination was bone marrow depression(48.3%);other reasons included patient subjective factors(31.0%),arrhythmia(5.9%),liver injury(5.9%),kidney injury(2.9%),and cerebral infarction(2.9%).Conclusion Completion of the established“sandwich”chemoradiotherapy can allow patients with stageⅢendometrial cancer to obtain a better prognosis.Improving the prevention and treatment of side effects and strengthening the education and management of these patients could help them complete the treatment regimen.