CAJ | 학술논문

目的回顾分析265例Ⅰ期子宫内膜癌术后放疗疗效和不良反应.方法 1999-2012年进行术后放疗的Ⅰ期子宫内膜癌患者共265例.病理类型为子宫内膜样腺癌占85.3％(226例).根据FIGO2009手术一病理分期.术后辅助放疗方式包括盆腔外照射35例(13.2％)、单纯阴道内照射107例(40.4％)和内外照射联合治疗123例(46.4％).Kaplan-Meier法计算生存率并Logrank检验差异,Cox模型进行预后因素分析.结果 5年随访率为85.7％.5年OS、PFS、局部复发、远处转移率分别为92.8％、89.7％、4.5％、6.4％.发生3级急性放射性肠炎者仅1例(0.4％),3、4级骨髓抑制者分别为4例(1.5％)、1例(0.4％),1例(0.4％)出现3级慢性肠炎.多因素分析显示子宫下段受累是影响OS和PFS的预后因素(P =0.041、0.001),放疗前贫血是影响OS的因素(P=0.048).结论子宫内膜样腺癌为主的Ⅰ期内膜癌患者进行术后辅助放疗的疗效良好,不良反应轻微,放疗前贫血和子宫下段受累是影响OS的重要因素.
목적 회고분석265례Ⅰ기자궁내막암술후방료료효화불량반응.방법 1999-2012년진행술후방료적Ⅰ기자궁내막암환자공265례.병리류형위자궁내막양선암점85.3％(226례).근거FIGO2009수술일병리분기.술후보조방료방식포괄분강외조사35례(13.2％)、단순음도내조사107례(40.4％)화내외조사연합치료123례(46.4％).Kaplan-Meier법계산생존솔병Logrank검험차이,Cox모형진행예후인소분석.결과 5년수방솔위85.7％.5년OS、PFS、국부복발、원처전이솔분별위92.8％、89.7％、4.5％、6.4％.발생3급급성방사성장염자부1례(0.4％),3、4급골수억제자분별위4례(1.5％)、1례(0.4％),1례(0.4％)출현3급만성장염.다인소분석현시자궁하단수루시영향OS화PFS적예후인소(P =0.041、0.001),방료전빈혈시영향OS적인소(P=0.048).결론 자궁내막양선암위주적Ⅰ기내막암환자진행술후보조방료적료효량호,불량반응경미,방료전빈혈화자궁하단수루시영향OS적중요인소.
Objective To retrospectively analyze the treatment outcomes and adverse reactions of 265 patients with stage Ⅰ endometrial carcinoma (EC) treated with postoperative radiotherapy.Methods Two hundred and sixty-five patients with stage Ⅰ EC were treated with hysterectomy and postoperative adjuvant radiotherapy from 1999 to 2012.The most common histological subtype of EC was adenocarcinoma (85.3％),and patients were staged according to the FIGO 2009 guidelines.The postoperative adjuvant radiotherapy methods included pelvic external beam radiotherapy (35 patients,13.2％),vaginal brachytherapy (107 patients,40.4％),and a combination of them (123 patients,46.4％).The Kaplan-Meier method was used to caculate survival rate,the log-rank test was used to for survival difference analysis,the Cox regression model was used for multivariate prognostic analysis.Results The 5-year following-up rate was 85.7％.The 5-year overall survival (OS),progression-free survival (PFS),local recurrence,and distant metastasis rates for all patients were 92.8％,89.7％,4.5％,and 6.4％,respectively.One patient (0.4％) developed grade 3 acute radiation enteritis,4 patients (1.5％) and 1 patient (0.4％) developed grade 3 and 4 myelosuppression,and 1 patient (0.4％) developed grade 3 chronic enteritis;no grade 3 or greater toxicities were noted.The multivariate analysis showed that involvement of the lower uterine was a significant predictor of OS (P =0.041) and PFS (P =0.001),whereas anemia before radiotherapy was a significant predictor of OS (P =0.048).Conclusions For patients with stage Ⅰ EC (mostly adenocarcinoma),postoperative radiotherapy has good efficacy and mild toxicities.Anemia before radiotherapy and involvement of the lower uterine are important predictors of OS.