CAJ | 학술논문

目的观察局部晚期宫颈癌根治性子宫切除术加术前同期放化疗(CRCT)、单纯放疗(RT)的疗效,并分析影响预后的因素.方法回顾分析2006-2011年收治的182例ⅠB2～ⅢB期宫颈癌患者资料,其中59例RT,123例术前每周顺铂40 mg/m2同期RT,放疗剂量40 ～ 50 Gy分20 ～ 25次.新辅助治疗后2～3周行全子宫、双附件及盆腔淋巴结切除术.采用Cox法行多因素预后分析.结果随访时间满3年者为69例.肿瘤直径≥4.5 cm时术前CRCT与RT的3年无进展生存(PFS)、总生存(OS)率均相似(x2=1.84、1.56,P=0.176、0.221),＜4.5 cm时术前CRCT比RT的PFS、OS率高(x2=5.22、4.81,P=0.022、0.018).全组3年PFS、OS率分别为92.0％、93.8％.Cox分析显示肿瘤直径(＜6 cm与≥6 cm)是PFS、OS的影响因素(x2=2.56、4.06,P=0.011、0.007),年龄(＜48岁与≥48岁)是OS的影响因素(x2=4.86,P=0.046),术后淋巴结状况(是否转移)是PFS的影响因素(x2=1.04,P=0.010).结论术前CRCT联合根治性子宫切除术可获较好生存率,原发病灶大小、年龄、术后淋巴结状况为重要预后因素.
목적 관찰국부만기궁경암근치성자궁절제술가술전동기방화료(CRCT)、단순방료(RT)적료효,병분석영향예후적인소.방법 회고분석2006-2011년수치적182례ⅠB2～ⅢB기궁경암환자자료,기중59례RT,123례술전매주순박40 mg/m2동기RT,방료제량40 ～ 50 Gy분20 ～ 25차.신보조치료후2～3주행전자궁、쌍부건급분강림파결절제술.채용Cox법행다인소예후분석.결과 수방시간만3년자위69례.종류직경≥4.5 cm시술전CRCT여RT적3년무진전생존(PFS)、총생존(OS)솔균상사(x2=1.84、1.56,P=0.176、0.221),＜4.5 cm시술전CRCT비RT적PFS、OS솔고(x2=5.22、4.81,P=0.022、0.018).전조3년PFS、OS솔분별위92.0％、93.8％.Cox분석현시종류직경(＜6 cm여≥6 cm)시PFS、OS적영향인소(x2=2.56、4.06,P=0.011、0.007),년령(＜48세여≥48세)시OS적영향인소(x2=4.86,P=0.046),술후림파결상황(시부전이)시PFS적영향인소(x2=1.04,P=0.010).결론 술전CRCT연합근치성자궁절제술가획교호생존솔,원발병조대소、년령、술후림파결상황위중요예후인소.
Objective To analyze the clinical outcome and prognostic factors of concurrent radiochemotherapy (CRCT) or radiotherapy (RT) alone followed by radical hysterectomy in cervical cancer.Methods Between April 2006 and June 2011,182 patients with FIGO ⅠB2-ⅢB cervical carcinoma were treated with preoperative CRCT ( 123 patients) or RT alone ( 59 patients) followed by radical surgery.Weekly cisplatin (40 mg/m2) were administered during radiotherapy for patients treated with CRCT.Preoperative RT doses were 40-50 Gy in 20-25 fractions.Total hysterosalpingo-oophorectomy and pelvic lymph node dissection was performed 2-3 weeks after neoadjuvant therapy.The prognostic factors were analyzed by Cox-regression method.Results Sixty-nine patients were followed up for 3 years.For patients with tumor ≥4.5 cm,there were no significant differences in the 3-year progression-free survival (PFS) and overall survival (OS) rates between CRCT and RT alone ( x2 =1.84 and 1.56,P =0.176 and 0.221 ).For patients with tumor ＜ 4.5 cm,CRCT group had higher PFS and OS rates than RT alone ( x2 =5.22 and 4.81,P=0.022 and 0.018).The 3-year PFS and OS rates were 92.0％ and 93.8％.By multivariate analysis,tumor diameter ( ≥6 cm vs.＜ 6 cm) was significant prognostic factor for PFS and OS (x2 =2.56,P =0.011 ;x2 =4.06,P =0.007 ),age ( ＜ 48 vs.≥ 48 years) was significant prognostic factor for OS (x2=4.86,P =0.046),and postoperative lymph node status (positive vs.negative) was significant prognostic factor for PFS ( x2 =1.04,P =0.010).Conclusions Treatment with CRCT or RT followed by radical surgery has achieved good OS and PFS for patients with FIGO ⅠB2-ⅢB cervical cancer.Tumor diameter,age and postoperative lymph node status are important prognostic factors for survival.