晚期或复发性子宫内膜癌患者新辅助化疗与患者预后的相关性分析

Correlation analysis of neoadjuvant chemotherapy with prognosis in patients with advanced or recurrent endometrial cancer

目的 探讨新辅助化疗(NAC)治疗晚期或复发子宫内膜癌(EC)患者的临床疗效及与患者预后的相关性。方法 将2019年1月至2022年8月四川大学华西第二医院收治的92例晚期EC或复发EC患者纳入本次回顾性研究,根据治疗方式不同分成研究组(n=50)和对照组(n=42)。研究组患者接受术前NAC+肿瘤细胞减灭术(CS)+术后化疗治疗,对照组患者接受CS+术后化疗治疗。比较两组的临床疗效、治疗后血清肿瘤标志物[包括糖类抗原(CA)-199、癌胚抗原(CEA)、CA-125]、治疗结束后1、2及3年生存情况和不良反应发生情况,多因素Logistic回归分析晚期或复发EC患者预后的危险因素。结果 研究组的客观有效率为72.00%,显著优于对照组(50.00%),差异有统计学意义(P<0.05)。研究组治疗后的血清CA-199、CEA和CA-125分别为(34.22±6.98) U/mL、(10.69±5.08)μg/L、(20.10±7.36) U/mL,均显著低于对照组[(50.19±8.03) U/mL、(20.34±6.18)μg/L、(38.15±7.17) U/mL],差异均有统计学意义(P<0.05)。两组1年的生存率比较,差异无统计学意义(P>0.05),研究组的2年和3年生存率分别为62.00%、52.00%,显著高于对照组(38.10%、26.19%),差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,病理分期为Ⅳ期或复发是EC患者肿瘤进展的独立危险因素(OR=2.128,95%CI:1.301~8.914,P=0.024),NAC是晚期或复发EC患者肿瘤进展的保护因素(OR=0.912,95%CI:0.509~0.964,P=0.010)。结论 NAC治疗可显著提高晚期EC或复发EC的疗效,显著延缓疾病进展,且安全性较高,病理分期为Ⅳ期或复发是EC患者肿瘤进展的独立危险因素,术前接受NAC是肿瘤进展的独立保护因素。

Objective To explore the clinical efficacy of neoadjuvant chemotherapy(NAC) in the treatment of advanced or recurrent endometrial cancer(EC) patients and analyze its correlation with prognosis.Methods A total of 92 cases of advanced or recurrent EC admitted to West China Second Hospital,Sichuan University from January 2019 to August 2022 were included in this retrospective study,and were divided into the study group(n=50) and the control group(n=42) based on different treatment methods.The study group received preoperative NAC+cytoreductive surgery(CS)+postoperative chemotherapy,while the control group received CS+postoperative chemotherapy.The clinical efficacy,serum tumor markers[including carbohydrate antigen(CA)-199,carcinoembryonic antigen(CEA),CA-125],survival rate 1,2,and 3 years after treatment and adverse reactions were compared.Multivariate Logistic regression analysis were used to assess the risk factors for the prognosis of advanced or recurrent EC patients.Results The objective response rate of the study group was 72.00%,which was significantly better than that of the control group(50.00%),the difference was statistically significant(P<0.05).The levels of serum CA-199,CEA,and CA-125 in the study group after treatment were(34.22±6.98) U/mL,(10.69±5.08) μg/L,and(20.10±7.36) U/mL,respectively,which were significantly lower than those in the control group[(50.19±8.03) U/mL,(20.34±6.18) μg/L,and(38.15±7.17)U/mL],the differences were statistically significant(P<0.05).There was no statistically significant difference on the 1-year survival rate between the two groups(P>0.05);the 2-year and 3-year survival rates of the study group were 62.00% and 52.00%,respectively,which were significantly higher than those of the control group(38.10% and 26.19%),the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Multivariate Logistic regression analysis showed that pathological stage Ⅳ or recurrence were independent risk factors for tumor progression in EC patients(OR=2.128,95%CI:1.301-8.914,P=0.024),while NAC was a protective factor for tumor progression in advanced or recurrent EC patients(OR=0.912,95%CI:0.509-0.964,P=0.010).Conclusion NAC can significantly improve the efficacy of advanced or recurrent EC,significantly delay disease progression,and have high safety.Pathological staging Ⅳ or recurrence is an independent risk factor for tumor progression in EC patients,and preoperative NAC is a independent protective factor for tumor progression.