CAJ | 학술논문

目的探讨中晚期（Ⅱb～Ⅳa期）子宫颈鳞癌同步放化疗的疗效及远处转移的影响因素。方法收集2006年1月至2010年12月于大连医科大学附属第二医院接受同步放化疗的118例中晚期子宫颈鳞癌患者的临床病理资料,患者的中位年龄为48岁（23～70岁）；临床分期：按国际妇产科联盟（FIGO）2009年的分期标准，Ⅱb期56例，Ⅲa期6例，Ⅲb期52例，Ⅳa期4例；肿瘤直径：>4 cm者55例，≤4 cm者63例；盆腔淋巴结转移：有转移者为35例，无转移者83例；治疗前血红蛋白（Hb）水平：≤110 g/L者为40例，>110 g/L者为78例；治疗前血清鳞状细胞癌抗原（SCC-Ag）水平：>1.5μg/L者91例，≤1.5μg/L者27例；治疗后SCC-Ag水平：>1.5μg/L者34例，≤1.5μg/L者84例。回顾性分析子宫颈鳞癌患者同步放化疗后的疗效及副反应，并对影响同步放化疗后远处转移的因素进行分析。结果（1）118例患者中，复发37例，复发率为31.4%（37/118）；其中局部复发者13例，远处转移者19例，局部复发和远处转移均有者5例。患者的5年总生存率为64.0%，5年无远处转移生存率为78.8%。急性副反应：2例发生Ⅲ级胃肠道反应（主要为腹泻），20例发生Ⅲ～Ⅳ度骨髓抑制；晚期放疗反应：5例发生Ⅲ～Ⅳ级胃肠道反应，2例发生Ⅲ或Ⅳ级膀胱反应。（2）单因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后血清SCC-Ag水平、治疗前Hb水平、盆腔淋巴结转移明显相关（P<0.05）；多因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后SCC-Ag水平、盆腔淋巴结转移明显相关（P<0.05）。结论中晚期子宫颈鳞癌患者同步放化疗的疗效满意，且安全性好。同步放化疗后远处转移的影响因素包括临床分期、治疗后血清SCC-Ag水平和盆腔淋巴结转移，对这些患者需要考虑新的治疗策略来控制远处转移。目的探討中晚期（Ⅱb～Ⅳa期）子宮頸鱗癌同步放化療的療效及遠處轉移的影響因素。方法收集2006年1月至2010年12月于大連醫科大學附屬第二醫院接受同步放化療的118例中晚期子宮頸鱗癌患者的臨床病理資料,患者的中位年齡為48歲（23～70歲）；臨床分期：按國際婦產科聯盟（FIGO）2009年的分期標準，Ⅱb期56例，Ⅲa期6例，Ⅲb期52例，Ⅳa期4例；腫瘤直徑：>4 cm者55例，≤4 cm者63例；盆腔淋巴結轉移：有轉移者為35例，無轉移者83例；治療前血紅蛋白（Hb）水平：≤110 g/L者為40例，>110 g/L者為78例；治療前血清鱗狀細胞癌抗原（SCC-Ag）水平：>1.5μg/L者91例，≤1.5μg/L者27例；治療後SCC-Ag水平：>1.5μg/L者34例，≤1.5μg/L者84例。迴顧性分析子宮頸鱗癌患者同步放化療後的療效及副反應，併對影響同步放化療後遠處轉移的因素進行分析。結果（1）118例患者中，複髮37例，複髮率為31.4%（37/118）；其中跼部複髮者13例，遠處轉移者19例，跼部複髮和遠處轉移均有者5例。患者的5年總生存率為64.0%，5年無遠處轉移生存率為78.8%。急性副反應：2例髮生Ⅲ級胃腸道反應（主要為腹瀉），20例髮生Ⅲ～Ⅳ度骨髓抑製；晚期放療反應：5例髮生Ⅲ～Ⅳ級胃腸道反應，2例髮生Ⅲ或Ⅳ級膀胱反應。（2）單因素分析顯示，中晚期子宮頸鱗癌患者同步放化療後遠處轉移與臨床分期、治療後血清SCC-Ag水平、治療前Hb水平、盆腔淋巴結轉移明顯相關（P<0.05）；多因素分析顯示，中晚期子宮頸鱗癌患者同步放化療後遠處轉移與臨床分期、治療後SCC-Ag水平、盆腔淋巴結轉移明顯相關（P<0.05）。結論中晚期子宮頸鱗癌患者同步放化療的療效滿意，且安全性好。同步放化療後遠處轉移的影響因素包括臨床分期、治療後血清SCC-Ag水平和盆腔淋巴結轉移，對這些患者需要攷慮新的治療策略來控製遠處轉移。
목적탐토중만기（Ⅱb～Ⅳa기）자궁경린암동보방화료적료효급원처전이적영향인소。방법수집2006년1월지2010년12월우대련의과대학부속제이의원접수동보방화료적118례중만기자궁경린암환자적림상병리자료,환자적중위년령위48세（23～70세）；림상분기：안국제부산과련맹（FIGO）2009년적분기표준，Ⅱb기56례，Ⅲa기6례，Ⅲb기52례，Ⅳa기4례；종류직경：>4 cm자55례，≤4 cm자63례；분강림파결전이：유전이자위35례，무전이자83례；치료전혈홍단백（Hb）수평：≤110 g/L자위40례，>110 g/L자위78례；치료전혈청린상세포암항원（SCC-Ag）수평：>1.5μg/L자91례，≤1.5μg/L자27례；치료후SCC-Ag수평：>1.5μg/L자34례，≤1.5μg/L자84례。회고성분석자궁경린암환자동보방화료후적료효급부반응，병대영향동보방화료후원처전이적인소진행분석。결과（1）118례환자중，복발37례，복발솔위31.4%（37/118）；기중국부복발자13례，원처전이자19례，국부복발화원처전이균유자5례。환자적5년총생존솔위64.0%，5년무원처전이생존솔위78.8%。급성부반응：2례발생Ⅲ급위장도반응（주요위복사），20례발생Ⅲ～Ⅳ도골수억제；만기방료반응：5례발생Ⅲ～Ⅳ급위장도반응，2례발생Ⅲ혹Ⅳ급방광반응。（2）단인소분석현시，중만기자궁경린암환자동보방화료후원처전이여림상분기、치료후혈청SCC-Ag수평、치료전Hb수평、분강림파결전이명현상관（P<0.05）；다인소분석현시，중만기자궁경린암환자동보방화료후원처전이여림상분기、치료후SCC-Ag수평、분강림파결전이명현상관（P<0.05）。결론중만기자궁경린암환자동보방화료적료효만의，차안전성호。동보방화료후원처전이적영향인소포괄림상분기、치료후혈청SCC-Ag수평화분강림파결전이，대저사환자수요고필신적치료책략래공제원처전이。
Objective To evaluate the outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy (CCRT). Methods A total of 118 patients with International Federation of Gynecology and Obstetrics (FIGO, 2009 version) stageⅡb-Ⅳa cervical squamous cell carcinoma treated with CCRT between 2006 and 2010 in the Second Affiliated Hospital of Dalian Medical University were analyzed. Their median age was 48 years (range, 23-70 years). FIGO stages were as follows:Ⅱb stage 56 cases,Ⅲa stage 6 cases,Ⅲb stage 52 cases, andⅣa stage 4 cases. Of the all patients, 55 cases showed bulkly tumor (tumor size>4 cm) and 35 cases were pelvic lymph node positive. Forty patients had pretreatment hemoglobin (Hb) levels no greater than 110 g/L. Patients with elevated squamous cell carcinoma antigen (SCC-Ag) >1.5 μg/L before CCRT and at one month after CCRT were 91 cases and 34 cases, respectively. Kaplan-Meier method was used to estimate survival. For the analysis of prognostic factors affecting distant metastasis, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis. Results Thirty-seven patients were diagnosed with recurrence, 19 cases of whom developed distant metastasis, 13 cases developed loco-regional recurrence and 5 cases had both distant and loco-regional recurrence. The 5-year overall survival rates and distant disease-free survival of all patients were 64.0% and 78.8%, respectively. Two patients had grade 3 acute gastrointestinal toxicity (mainly diarrhea) and 20 cases had grade 3 to 4 hematologic toxicity. Seven patients experienced grade 3 to 4 late toxicity, 5 cases of them were gastrointestinal and 2 cases were genitourinary toxicity. Univariate analysis showed that FIGO stages, SCC-Ag level at one month after treatment, pretreatment hemoglobin level, and pelvic lymph node metastasis were significantly correlated with distant metastasis (all P<0.05). Multivariate analysis showed that FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis were independent prognostic factors for distant metastasis (all P<0.05). Conclusions For stageⅡb-Ⅳa cervical squamous cell carcinoma, the regimen of CCRT was efficacious and safe. The predictive factors for distant metastasis in patients withⅡb-Ⅳa stage squamous cell carcinoma of cervix treated with CCRT included FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis. New treatment strategies should be considered to control distant metastasis for these patients.