紫杉醇联合顺铂与单药顺铂2种同步放化疗方案对中晚期宫颈癌患者预后的影响及安全性评价

发布时间：2018-02-11 00:43

  本文关键词： 紫杉醇 顺铂 宫颈肿瘤 预后因素 安全性　出处：《吉林大学学报(医学版)》2017年05期 　论文类型：期刊论文

【摘要】：目的:探讨影响中晚期宫颈癌患者预后的相关因素,评价单药顺铂与紫杉醇联合顺铂(TP)2种方案对患者预后的影响及安全性,为中晚期宫颈癌的临床治疗提供依据。方法:选取在吉林大学第二医院放疗科行紫杉醇联合顺铂或单药顺铂2种同步放化疗方案的中晚期宫颈癌患者218例,根据其同步放化疗方案将所有患者分为单药顺铂组和紫杉醇联合顺铂组。所有患者均行体外照射联合高剂量率腔内近距离治疗。回顾性收集218例患者的年龄、肿瘤直径、临床分期、化疗方案、病理等级、病理类型和初产年龄等临床资料及治疗后的不良反应,并通过电话随访及门诊、住院复查资料的方式收集患者的生存资料,随访日期截止至2017年1月。比较2组患者临床病理资料的差异,分析所有患者临床病理资料与预后的关联性并评价2种同步放化疗方案的安全性。结果:2组患者年龄、肿瘤直径、临床分期、病理等级、病理类型和初产年龄比较差异无统计学意义(P0.05)。218例患者的1、3和5年生存率分别为96.33%、76.15%和63.76%,紫杉醇联合顺铂组患者5年生存率高于单药顺铂组(χ2=8.032,P=0.005)。单因素分析结果,与患者预后有关的因素是肿瘤直径、临床分期、化疗方案和病理类型为腺癌(P0.05)。多因素分析结果,患者的临床分期[Ⅲ期:P=0.016,HR(95%CI)=1.90(1.13~3.19);Ⅳ期:P0.001,HR(95%CI)=19.13(7.84~46.68)],化疗方案[P=0.009,HR(95%CI)=0.54(0.34~0.86)]和病理类型为腺癌[P=0.021,HR(95%CI)=1.88(1.10~3.21)]是其预后的独立影响因素,且临床分期处于ⅡB期、采用紫杉醇联合顺铂同步放化疗方案和病理类型为鳞癌的患者预后较好。与紫杉醇联合顺铂组患者比较,单药顺铂组患者白细胞减少症(Z=-2.060,P=0.039)和嗜中性粒细胞减少症(Z=-2.246,P=0.025)不良反应较轻。结论:临床分期、化疗方案和腺癌病理类型是中晚期宫颈癌患者预后的独立影响因素。与采用单药顺铂比较,采用紫杉醇联合顺铂同步化疗方案患者预后较好,且不良反应仅略重于采用单药顺铂。
[Abstract]:Objective: to investigate the prognostic factors of patients with advanced cervical cancer, and to evaluate the effect and safety of cisplatin and paclitaxel combined with cisplatin and TPN on the prognosis of patients with advanced cervical cancer. Methods: 218 patients with advanced cervical cancer who were treated with paclitaxel combined with cisplatin or single drug cisplatin in radiotherapy department of Jilin University second Hospital were selected. All patients were divided into single cisplatin group and paclitaxel combined with cisplatin group according to their concurrent radiotherapy and chemotherapy regimen. All patients were treated with external irradiation combined with high dose rate brachytherapy. The age and tumor diameter of 218 patients were collected retrospectively. Clinical data such as clinical stage, chemotherapy regimen, pathological grade, pathological type and age of first parturition, and adverse reactions after treatment were collected by telephone follow-up and outpatient, in-patient reexamination data. The follow-up date was up to January 2017. The differences of clinicopathological data between the two groups were compared, the correlation between clinicopathologic data and prognosis was analyzed, and the safety of two concurrent radiotherapy and chemotherapy regimens was evaluated. Tumor diameter, clinical stage, pathological grade, There was no significant difference in pathological type and age of first delivery. The 1- and 5-year survival rates of 218 patients were 96.33% and 63.76%, respectively. The 5-year survival rate in paclitaxel combined with cisplatin group was higher than that in single-drug cisplatin group (蠂 ~ 2 / 8.032P ~ (0.005)). The results of univariate analysis showed that the 5-year survival rate of patients with paclitaxel combined with cisplatin was significantly higher than that of cisplatin group. The prognostic factors were tumor diameter, clinical stage, chemotherapy regimen and pathological type. The clinical stage of the patients [stage 鈪，

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