不同T和N分期的ⅢCr期宫颈癌患者根治性放疗后疗效分析

The prognosis ofⅢCr stage cervical cancer patients with different T and N status after radical radiotherapy

目的评估国际妇产科协会(FIGO)2018分期中ⅢCr期宫颈癌接受根治性放化疗后不同T分期和淋巴结状态患者之间的疗效差异。方法回顾性分析浙江省肿瘤医院2013年9月至2016年12月收治的根治性放疗的原发ⅢCr期宫颈癌患者资料279例。根据美国癌症联合委员会(AJCC)最新的TNM分期,将患者根据不同局部宫颈肿瘤状态分为T2a、T2b、T3a、T3b期,根据不同淋巴结状态分为N1、N2期。根据淋巴结最大短径,分为<1.85 cm组和≥1.85 cm组。根据转移淋巴结数目,分为≤3枚组和>3枚组。采用Kaplan-Meier法和log-rank检验分析比较不同T分期和淋巴结状态患者之间的无进展生存(PFS)和总生存(OS)差异,采用Cox回归进行生存相关的多因素分析。结果279例患者中,T2a期6例(2.2%),T2b期109例(39.1%),T3a期13例(4.7%),T3b期151例(54.1%);N1期246例(88.2%),N2期33例(11.8%)。淋巴结最大短径<1.85 cm组有229例(82.1%),≥1.85 cm组50例(17.9%);转移淋巴结数目≤3枚组269例(96.4%),>3枚组10例(3.6%)。不同T分期患者之间,5年PFS率(P=0.136)和5年OS率差异均无统计学意义(P=0.050),其中T3a期患者预后最差(5年OS率为38.5%);淋巴结最大短径≥1.85 cm组患者的PFS率及OS率均显著差于<1.85 cm组(5年PFS率为48.0%∶64.2%,P=0.016;5年OS率为52.0%∶73.8%,P=0.001)。N1期与N2期患者之间,PFS率和OS率差异均无统计学意义,5年PFS率为61.0%∶63.6%(P=0.796),5年OS率为67.5%∶69.7%(P=0.770)。转移淋巴结数目≤3枚组与>3枚组患者之间,PFS率和OS率差异均无统计学意义,5年PFS率为61.0%∶70.0%(P=0.653),5年OS率为67.3%∶80.0%(P=0.447)。不同T分期、淋巴结状态组合的患者中,T2b期且淋巴结最大短径≥1.85 cm的患者预后最差(5年OS率为31.3%),T2b期且淋巴结最大短径<1.85 cm的患者预后最好(5年OS率为76.3%)。多因素分析发现,淋巴结最大短径及淋巴结放疗剂量为影响ⅢCr期宫颈癌患者OS期的独立相关因素(P<0.05)。结论在接受根治性放疗的ⅢCr期宫颈癌患者中,不同T分期和淋巴结状态患者的疗效和预后存在较大差异,需要进一步细化目前的分期,以更好地制订诊疗方案。

ObjectiveTo compare the difference of prognosis inⅢCr stage cervical cancer patients with different T stage and lymph node status who received radical radiotherapy.MethodsClinical data of 279 patients withⅢCr stage cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed.According to the latest American Joint Committee on Cancer(AJCC)TNM stage,all patients were divided into T 2a,T 2b,T 3a and T 3b stage groups,and N 1 and N 2 stage groups based on lymph node status.They were also divided into<1.85 cm and≥1.85 cm groups according to the maximum short diameter of lymph node.In addition,they were assigned into≤3 and>3 groups according to the number of lymph node metastasis.The differences of progression-free survival(PFS)and overall survival(OS)between patients with different T stage and lymph node status were compared by Kaplan-Meier test and log-rank test.Multivariate survival analysis was performed by Cox regression analysis.ResultsAmong 279 patients withⅢCr stage cervical cancer receiving radical radiotherapy,6(2.2%)patients were diagnosed with stage T 2a stage,109(39.1%)patients with T 2b stage,13(4.7%)patients with T 3a stage,and 151(54.1%)patients with T 3b stage.And 246(88.2%)patients were diagnosed with N 1 stage and 33(11.8%)patients with N 2 stage.According to the maximum short diameter of lymph nodes,there were 229(82.1%)patients in the<1.85 cm group and 50(17.9%)in the≥1.85 cm group.According to the number of lymph node metastasis,there were 269(96.4%)patients in the≤3 group and 10(3.6%)in the>3 group.There was no significant difference in the 5-year PFS(P=0.136)and OS rates(P=0.050)among patients with different T stages,and patients with T 3a stage had the worst prognosis(5-year OS rate was 38.5%).The 5-year PFS(48.0%vs.64.2%,P=0.016)and OS rates(52.0%vs.73.8%,P=0.001)in the≥1.85 cm group were significantly lower than those in the<1.85 cm group.There was no significant difference in the 5-year PFS(61.0%vs.63.6%,P=0.796)and OS rates(67.5%vs.69.7%,P=0.770)between patients with N 1 and N 2 stages.There was no significant difference in the 5-year PFS(61.0%vs.70.0%,P=0.653)and OS rates(67.3%vs.80.0%,P=0.447)between patients in the number of metastatic lymph nodes≤3 and>3 groups.The prognosis of patients with T 2b stage and the maximum short diameter≥1.85 cm was the worst(5-year OS rate was 31.3%),while patients with T 2b stage and the maximum short diameter<1.85 cm obtained the best prognosis(5-year OS rate was 76.3%).Multivariate analysis showed that the maximum short diameter and radiation dose of lymph nodes were the independent relevant factors for the OS ofⅢCr stage cervical cancer patients(both P<0.05).ConclusionsAmongⅢCr stage cervical cancer patients receiving radical radiotherapy,clinical efficacy and prognosis significantly differ according to different T stage and lymph node status.Current staging system should be optimized to provide effective diagnostic and therapeutic regimens.