不同治疗模式对ⅡB期宫颈癌患者预后和生活质量的影响

Impact of Different Treatment Models on Prognosis and QOL of Patients with Stage ⅡB Cervical Cancer

目的评价不同治疗方式对ⅡB期宫颈癌患者预后及生活质量的影响。方法回顾性分析2000年01月01日至2010年12月31日,在广西医科大学附属肿瘤医院妇瘤科住院治疗的269例ⅡB期宫颈癌患者的病例资料,根据不同治疗方式分成4组。组1:单纯放射治疗组43例;组2:同步放化疗组98例;组3:新辅助化疗或放化疗+手术组76例;组4:新辅助化疗或放化疗+手术+术后放疗和(或)化疗组52例,比较各组患者的5年生存率、5年无瘤生存率及生活质量,并分析影响预后的因素。结果组2的预后最好,组4的预后最差;组2的预后优于组3,但差异无统计学意义;组1的预后优于组4,差异无统计学意义;组2、组3的预后优于组1、组4,差异有统计学意义。组1及组2的生活质量较差。结论新辅助化疗或放化疗后加手术治疗尽管可改善部分ⅡB期宫颈癌的预后及生活质量,但仍需进一步开展前瞻性随机对照临床研究进一步证实。

Objective To evaluate the clinical effect of different treatment models on the prognosis and quality of life(QOL) of patients with stage ⅡB cervical cancer. Methods A total of 269 patients with stage ⅡB cervical cancer treated at Dept. of Gynecological Oncology of The Affi liated Tumor Hospital of Guangxi Medical University from January 1, 2000 to December 31, 2010 were retrospectively analysed and divided into 4 groups, Group 1: exclusive radiotherapy(43 cases), Group 2: concurrent chemoradiotherapy(96 cases), Group 3: neoadjuvant chemotherapy(NACT) or chemoradiotherapy plus radical hysterectomy and pelvic lymphadenectomy(76 cases), Group 4: Group3 followed adjuvant radiotherapy and/or chemotherapy(52 cases). The 5-year overall survival rate(OS), 5-year disease free survival rate(DFS) and QOL were compared and influence factors for survival were analyzed among 4 groups. Results Group 2 was with the best OS, however, Group 4 was with the worst OS. OS of Group 2 and 1 were better than those of Group 3 and 4 respectively, with no signifi cant difference. OS of Group 2 and 3 were better than those of Group 1 and 4(P<0.05). QOL of both Group 1 and Group 2 were worse. Conclusion NACT or chemoradiotherapy plus surgery could improve OS, DFS and QOL of partial patients with stage ⅡB cervical cancer. More clinical trials are required to demonstrate the conclusion.