大连医科大学学报
大連醫科大學學報
대련의과대학학보
JOURNAL OF DALIAN MEDICAL UNIVERSITY
2015年
2期
151-156
,共6页
宫颈肿瘤%手术%放疗%临床疗效%不良反应%预后
宮頸腫瘤%手術%放療%臨床療效%不良反應%預後
궁경종류%수술%방료%림상료효%불량반응%예후
cervical carcinoma%surgery%radiotherapy%clinical efficacy%toxicity%prognosis
目的：比较Ⅱ期宫颈癌根治术加术前同期放化疗与根治性放疗同期化疗的临床疗效、预后因素及远期不良反应。方法回顾分析大连市第三人民医院妇瘤科2001年1月—2008年12月收治的207例Ⅱa－Ⅱb期宫颈鳞癌患者的临床资料。119例行根治术结合术前同期放化疗（手术组），88例行根治性放疗及同期化疗（放化疗组），化疗方案为PF／TP。观察两组间的5年无进展生存（ PFS）、总生存（ OS）及远期不良反应的发生率。结果患者5年总生存率（OS）为手术组73．95％，放化疗组54．02％；总无进展生存率（PFS）为手术组71．43％，放化疗组49．43％。78例复发，其中51例（65％）为局部复发，18例（23％）为远处转移，9例（12％）为局部复发＋远处转移。单因素及多因素分析均显示，治疗前SCC值、治疗后1个月SCC值是否降至＜1．5 mg／L及是否手术这3个因素与总生存时间相关（RR分别为0．066、0．045、2．604，P均＜0．05）。手术组下肢水肿、生殖道瘘发生率较高（P均＜0．05），放化疗组放射性肠炎、膀胱炎发生率较高（P均＜0．05）。结论Ⅱ期宫颈鳞癌患者，根治术联合术前同期放化疗能获得较好预后。治疗前SCC值≥1．5 mg／L，治疗后1个月SCC值未下降至＜1．5 mg／L及未行手术治疗者预后较差。
目的：比較Ⅱ期宮頸癌根治術加術前同期放化療與根治性放療同期化療的臨床療效、預後因素及遠期不良反應。方法迴顧分析大連市第三人民醫院婦瘤科2001年1月—2008年12月收治的207例Ⅱa－Ⅱb期宮頸鱗癌患者的臨床資料。119例行根治術結閤術前同期放化療（手術組），88例行根治性放療及同期化療（放化療組），化療方案為PF／TP。觀察兩組間的5年無進展生存（ PFS）、總生存（ OS）及遠期不良反應的髮生率。結果患者5年總生存率（OS）為手術組73．95％，放化療組54．02％；總無進展生存率（PFS）為手術組71．43％，放化療組49．43％。78例複髮，其中51例（65％）為跼部複髮，18例（23％）為遠處轉移，9例（12％）為跼部複髮＋遠處轉移。單因素及多因素分析均顯示，治療前SCC值、治療後1箇月SCC值是否降至＜1．5 mg／L及是否手術這3箇因素與總生存時間相關（RR分彆為0．066、0．045、2．604，P均＜0．05）。手術組下肢水腫、生殖道瘺髮生率較高（P均＜0．05），放化療組放射性腸炎、膀胱炎髮生率較高（P均＜0．05）。結論Ⅱ期宮頸鱗癌患者，根治術聯閤術前同期放化療能穫得較好預後。治療前SCC值≥1．5 mg／L，治療後1箇月SCC值未下降至＜1．5 mg／L及未行手術治療者預後較差。
목적：비교Ⅱ기궁경암근치술가술전동기방화료여근치성방료동기화료적림상료효、예후인소급원기불량반응。방법회고분석대련시제삼인민의원부류과2001년1월—2008년12월수치적207례Ⅱa－Ⅱb기궁경린암환자적림상자료。119례행근치술결합술전동기방화료（수술조），88례행근치성방료급동기화료（방화료조），화료방안위PF／TP。관찰량조간적5년무진전생존（ PFS）、총생존（ OS）급원기불량반응적발생솔。결과환자5년총생존솔（OS）위수술조73．95％，방화료조54．02％；총무진전생존솔（PFS）위수술조71．43％，방화료조49．43％。78례복발，기중51례（65％）위국부복발，18례（23％）위원처전이，9례（12％）위국부복발＋원처전이。단인소급다인소분석균현시，치료전SCC치、치료후1개월SCC치시부강지＜1．5 mg／L급시부수술저3개인소여총생존시간상관（RR분별위0．066、0．045、2．604，P균＜0．05）。수술조하지수종、생식도루발생솔교고（P균＜0．05），방화료조방사성장염、방광염발생솔교고（P균＜0．05）。결론Ⅱ기궁경린암환자，근치술연합술전동기방화료능획득교호예후。치료전SCC치≥1．5 mg／L，치료후1개월SCC치미하강지＜1．5 mg／L급미행수술치료자예후교차。
Objective To compare the clinical efficacy,prognosis and long-term toxicities of radical surgery plus preoper-ative chemoradiotherapy with radical radiotherapy plus concurrent chemotherapy in the treatment of stage IIa and IIb cervical carcinoma patients.Methods Retrospective analysis was performed on 207 patients with stageⅡsquamous cervical carcino-ma in our Hospital from January 2001 to December 2008.119 patients received radical surgery and preoperative chemoradio-therapy ( RHT) and 88 Patients received radical radiotherapy and concurrent chemotherapy ( RCT) with PF or TP chemo-therapy regimen.5-year overall survival rate,5-year progression free survival rate and incidence rate of early and late side-effect were analyzed.Results In the 207 patients,the 5-year overall survival rate(OS) was 73.95%in group RHT and 54.02%in group RCT;the 5-year disease-free survival rate( PFS) was 71.43% in group RHT and 49.43% in group RCT.78 patients had recurrent cancer with either local recurrences (51 patients,65%),distant metastases (18 pa-tients,23%) or both (9 patients,12%) .Univariate and multivariate analysis showed that overall survival time was corre-lated to squamous cell carcinoma antigen ( SCC) levels before and 1 month after treatment and whether received surgery (RR=0.066,0.045 and 2.604, respectively, P<0.05).Leg edema and urogenital fistula occurred more frequently in group RHT than in group RCT (all P<0.05),while radiation enteritis and radiation urocystitis more frequently in group RCT than in group RHT (all P<0.05).Conclusions By radical surgery with preoperative radiochemotherapy,stage IIa and IIb squamous cervical carcinoma patients obtained better prognosis.Patients who had SCC level ≥1.5 mg/L before treat-ment,SCC level ≥1.5 mg/L 1 month after treatment and without surgery had poor prognosis.
