Effect observation of postoperative radiotherapy combined with systemic chemotherapy in treating patients with cervical cancer in early stage
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摘要:目的
评估术后放疗联合全身化疗治疗早期宫颈癌的临床效果。
方法回顾性分析152例Ⅰb~Ⅱa期宫颈癌术后放疗患者的临床资料，并分为放疗联合全身化疗组和单纯放疗组，每组76例。比较2组临床资料及复发转移情况。
结果152例早期宫颈癌患者术后放疗后复发率为20.39%。单因素及多因素分析显示，脉管癌栓、深间质浸润、宫旁侵犯、盆腔淋巴结转移是宫颈癌术后放疗后复发的独立危险因素(P < 0.05)。放疗联合全身化疗组的腺癌及其他病理类型、肿瘤直径大、有脉管癌栓、盆腔淋巴结转移比率均高于单纯放疗组，差异有统计学意义(P < 0.05或P < 0.01)。在88例老年(≥50岁)早期宫颈癌患者中，单因素及多因素分析显示，宫旁侵犯、盆腔淋巴结转移是老年宫颈癌患者术后放疗后复发的独立危险因素(P < 0.05)。
结论脉管癌栓、深间质浸润、宫旁侵犯、盆腔淋巴结转移是早期宫颈癌患者术后放疗后复发的独立危险因素。对于伴有中高危险因素的早期宫颈癌患者，术后放疗联合全身化疗有助于减少复发风险。宫旁侵犯、盆腔淋巴结转移是老年早期宫颈癌患者术后复发的独立危险因素。
Abstract:ObjectiveTo evaluate the clinical effect of postoperative radiotherapy combined with systemic chemotherapy in treating patients with cervical cancer in early stage.
MethodsThe clinical materials of 152 patients with postoperative radiotherapy in stage Ⅰb to Ⅱa of cervical cancer were retrospectively analyzed, and they were divided into radiotherapy combined with systemic chemotherapy group and simple radiotherapy group, with 76 cases in each group. The clinical materials and conditions of recurrence and metastasis were compared between the two groups.
ResultsIn the 152 patients with cervical cancer in early stage, the recurrence rate after postoperative radiotherapy was 20.39%. Univariate and multivariate analyses showed that vascular cancer thrombus, deep interstitial infiltration, parametrial infiltration and pelvic lymph node metastasis were the independent risk factors for postoperative recurrence of cervical cancer after radiotherapy (P < 0.05). In the radiotherapy combined with systemic chemotherapy group, the ratios of patients with adenocarcinoma and other pathological types, larger tumor diameter, vascular cancer thrombus and pelvic lymph node metastasis were significantly higher than those in the simple radiotherapy group (P < 0.05 or P < 0.01). In the 88 elderly (≥50 years old) patients with cervical cancer in early stage, univariate and multivariate analyses showed that parametrial invasion and pelvic lymph node metastasis were the independent risk factors of postoperative recurrence after radiotherapy in elderly patients with cervical cancer (P < 0.05).
ConclusionVascular cancer thrombus, deep interstitial infiltration, parametrial infiltration and pelvic lymph node metastasis are the independent risk factors for postoperative recurrence after radiotherapy in patients with cervical cancer in early stage. For early cervical cancer patients with moderate to high risk factors, postoperative radiotherapy combined with systemic chemotherapy can help reduce risk of recurrence. Parametrial infiltration and pelvic lymph node metastasis are the independent risk factors of postoperative recurrence in elderly patients with cervical cancer in early stage.
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Keywords:
- cervical cancer /
- radiotherapy /
- chemotherapy /
- recurrence /
- risk factors
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表 1 早期宫颈癌患者术后放疗后复发相关因素的单因素分析
例 影响因素 分类 n 复发组(n=31) 未复发组(n=121) 复发率/% χ2 P 年龄 < 50岁 64 9 55 14.06 2.730 0.098 ≥50岁 88 22 66 25.00 FIGO分期 Ⅰb1~Ⅰb3 105 16 89 15.24 5.562 0.018 Ⅱa1~Ⅱa2 47 15 32 31.91 病理类型 鳞癌 131 24 107 18.32 2.512 0.113 腺癌及其他 21 7 14 33.33 病理分级 低分化 49 13 36 26.53 1.677 0.195 中高分化 103 18 85 17.48 肿瘤直径 < 4 cm 96 18 78 18.75 0.434 0.510 ≥4 cm 56 13 43 23.21 脉管癌栓 无 60 4 56 6.67 11.507 0.001 有 92 27 65 29.35 宫颈浸润深度 < 1/2层 45 2 43 4.44 10.017 0.002 ≥1/2层 107 29 78 27.10 手术切缘 无 146 28 118 19.18 3.372 0.066 有 6 3 3 50.00 宫旁侵犯 无 139 22 117 15.83 20.883 < 0.001 有 13 9 4 69.23 盆腔淋巴结转移 无 106 11 95 10.38 21.649 < 0.001 有 46 20 26 43.48 联合全身化疗 无 76 11 65 14.47 3.282 0.070 有 76 20 56 26.32 
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表 2 早期宫颈癌患者术后放疗后复发的多因素Logistic回归模型分析
因素 B SE Wald OR 95%CI P FIGO分期 0.633 0.530 1.430 1.884 0.667~5.319 0.232 脉管癌栓 1.765 0.628 7.908 5.841 1.707~19.986 0.005 深间质浸润 2.147 0.816 6.929 8.559 1.730~42.333 0.008 宫旁侵犯 2.053 0.760 7.293 7.789 1.756~34.555 0.007 盆腔淋巴结转移 1.455 0.517 7.902 4.283 1.553~11.808 0.005 常量 -5.470 1.016 29.009 0.004 — < 0.001
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表 3 放疗联合全身化疗组与单纯放疗组临床病理特征比较
例 临床病理特征 分类 n 放疗联合全身化疗组(n=76) 单纯放疗组(n=76) χ2 P 年龄 < 50岁 64 34 30 0.432 0.511 ≥50岁 88 42 46 FIGO分期 Ⅰb1~Ⅰb3 105 47 58 3.727 0.054 Ⅱa1~Ⅱa2 47 29 18 病理类型 鳞癌 131 61 70 4.475 0.034 腺癌及其他 21 15 6 病理分级 低分化 49 28 21 1.476 0.224 中高分化 103 48 55 肿瘤直径 < 4 cm 96 42 54 4.071 0.044 ≥4 cm 56 34 22 脉管癌栓 无 60 21 39 8.922 0.003 有 92 55 37 宫颈浸润深度 < 1/2层 45 20 25 0.789 0.374 ≥1/2层 107 56 51 手术切缘 无 146 71 75 1.562 0.211 有 6 5 1 宫旁侵犯 无 139 67 72 2.103 0.147 有 13 9 4 盆腔淋巴结转移 无 106 38 68 28.056 < 0.001 有 46 38 8 复发转移 无 121 56 65 3.282 0.070 有 31 20 11
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表 4 放疗联合全身化疗组与单纯放疗组复发转移情况比较
例 复发转移部位 分类 放疗联合全身化疗组(n=76) 单纯放疗组(n=76) 盆腔复发 盆腔淋巴结 1 2 盆腔软组织 1 3 盆骨 3 0 盆腔软组织及盆骨 1 1 远处转移 远处骨 1 0 肺 4 1 肺及骨 0 1 肝及肺和胸腹部淋巴结 1 0 腹部淋巴结 3 0 胸膜及腹膜 1 0 肺及腹部淋巴结 1 0 脑及颈胸腹部淋巴结 1 0 肺及腹膜 0 1 颈胸腹部淋巴结 0 1 腹膜 1 0 盆腔及远处复发 肝及盆骨 0 1 腹盆腔淋巴结及盆腔软组织 1 0
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表 5 早期老年宫颈癌患者术后放疗后复发相关因素的单因素分析
例 影响因素 分类 n 复发组(n=22) 未复发组(n=66) 复发率/% χ2 P FIGO分期 Ⅰb1~Ⅰb3 55 11 44 20.00 1.956 0.162 Ⅱa1~Ⅱa2 33 11 22 33.33 病理类型 鳞癌 77 17 60 22.08 2.805 0.094 腺癌及其他 11 5 6 45.45 病理分级 低分化 31 10 21 32.26 1.345 0.246 中高分化 57 12 45 21.05 肿瘤大小 < 4 cm 49 11 38 22.45 0.384 0.536 ≥4 cm 39 11 28 28.21 脉管癌栓 无 38 4 34 10.53 7.472 0.006 有 50 18 32 36.00 宫颈浸润深度 < 1/2层 23 2 21 8.70 4.415 0.036 ≥1/2层 65 20 45 30.77 手术切缘 无 82 19 63 23.17 2.146 0.143 有 6 3 3 50.00 宫旁侵犯 无 77 14 63 18.18 15.273 < 0.001 有 11 8 3 72.73 盆腔淋巴结转移 无 63 8 55 12.70 17.898 < 0.001 有 25 14 11 56.00 联合全身化疗 无 46 9 37 19.57 1.518 0.218 有 42 13 29 30.95
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表 6 早期老年宫颈癌患者术后放疗后复发的多因素Logistic回归模型分析
相关因素 B SE Wald OR 95%CI P 脉管癌栓 1.267 0.733 2.991 3.550 0.845~14.921 0.084 深间质浸润 1.493 0.882 2.863 4.448 0.789~25.064 0.091 宫旁侵犯 2.279 0.863 6.965 9.763 1.798~53.022 0.008 盆腔淋巴结转移 1.920 0.652 8.666 6.818 1.899~24.477 0.003 常量 -4.263 1.072 15.821 0.014 — < 0.001
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