136例中晚期宫颈癌同步放化疗生存及预后因素分析

发布时间：2018-12-06 14:52

【摘要】：目的： 通过回顾性分析136例中晚期同步放化疗的宫颈癌患者5年生存率，并分析其相关预后因素，以期望找到可变因素来提高同步放化疗宫颈癌患者的生存率。 资料与方法： 回顾性分析2007年3月到2008年9月辽宁省肿瘤医院收治的136例同步放化疗的宫颈癌患者，FIGO（国际妇产科联盟）分期为IIb期和IIIb期；患者全部完成了放射治疗（外照射和腔内放疗）及化疗（DDP+5fu），患者生存率计算采用Kaplan—Meier法，生存率差异检验采用log-rank test方法，多因素分析采用Cox回归分析方法。 结果： 中位随访时间为61.9个月(从4.6个月-79.6个月)，其中死亡患者共46例，死亡原因均为肿瘤复发或转移，患者5年总体生存率为66.2%；单因素分析结果显示患者分为青年组、中年组及老年组，总的5年生存率分别为：50%、73%和37.5%，，P=0.012，差异有统计学意义；IIB期和IIIB期患者的总的5年生存率分别为82.9%和60.4%，P=0.014，差异有统计学意义；鳞癌患者和腺癌患者的总的5年生存率分别为68.5%和16.7%，P=0.00，差异有统计学意义；高分化、中分化及低分化患者的总的5年生存率分别为67.7%、71%和25%，P=0.001，差异有统计学意义，但是高分化患者和中分化患者的5年生存率之间的差异并没有统计学意义（P=0.637）；肿瘤直径＜4cm、4—6cm和＞6cm患者的总的5年生存率分别为75%、65.2%和40%，P=0.017，差异有统计学意义；放化疗前血红蛋白Hb水平＜110g/L和≥110g/L的患者的总的5年生存率分别为41.7%和71.5%，P=0.012，差异有统计学意义；放疗天数≤9周和放疗天数＞9周的患者的总的5年生存率分别为76.1%和56.5%，P=0.018，差异有统计学意义；以上均为对患者生存时间有显著影响的临床病理因素，而肿瘤大体类型分为菜花型、溃疡型、颈管型、结节型和混合型，5年生存率分别为69.8%、68.6%、100%、53.6%和50%，对患者生存率的影响无统计学意义（P=0.285）；多因素分析显示临床分期（P=0.01）、分化程度（P=0.001）、治疗前血红蛋白Hb水平（P=0.004）及完成放疗时间（P=0.026）是对生存率有显著影响的独立预后因素。肿瘤直径（P=0.313）、病理类型（P=0.155）、年龄（P=0.775）和肿瘤大体类型（P=0.176）对患者总的5年生存率的影响无显著性意义。 结论： 统计分析结果显示患者5年生存率与其他一些国内和外文资料具有可比性，在中晚期宫颈癌患者临床治疗中，临床分期和分化程度等病理因素均为不可变性因素，但是我们可通过改变患者其它可变性因素来改善宫颈癌患者的预后，例如提高治疗前血红蛋白Hb水平和严格遵循放疗计划避免放疗间歇。
[Abstract]:Objective: to retrospectively analyze the 5-year survival rate of 136 patients with advanced cervical cancer treated with concurrent radiotherapy and chemotherapy, and analyze the related prognostic factors in order to find variable factors to improve the survival rate of cervical cancer patients with concurrent radiotherapy and chemotherapy. Materials and methods: from March 2007 to September 2008, 136 patients with cervical cancer treated in Liaoning Cancer Hospital were divided into IIb stage and IIIb stage according to the, FIGO (International Federation of Gynecology and Obstetrics and Gynecology. All patients were treated with radiotherapy (external and intracavitary radiotherapy) and chemotherapy (DDP 5fu). The survival rate was calculated by Kaplan-Meier method, log-rank test method was used for differential survival test, and Cox regression analysis was used for multivariate analysis. Results: the median follow-up time was 61.9 months (from 4.6 months to 79.6 months), of which 46 patients died. The causes of death were tumor recurrence or metastasis, and the overall 5-year survival rate was 66.2%. The results of univariate analysis showed that the patients were divided into three groups: young group, middle age group and elderly group. The overall 5-year survival rates were: 50% and 37.5%, respectively. The difference was statistically significant. The overall 5-year survival rate in patients with IIB and IIIB was 82.9% and 60.4%, respectively. The difference was statistically significant. The overall 5-year survival rate of patients with squamous cell carcinoma and adenocarcinoma was 68.5% and 16.7%, respectively. The difference was statistically significant. The overall 5-year survival rates of highly, moderately and poorly differentiated patients were 67.7% and 25%, respectively. The difference was statistically significant. However, there was no significant difference in 5-year survival rate between well-differentiated and moderately differentiated patients (P0. 637). The overall 5-year survival rates of patients with tumor diameter < 4cm ~ 4-6cm and > 6cm were 75% and 40%, respectively. The difference was statistically significant. The overall 5-year survival rates of patients with hemoglobin Hb level < 110g/L and 鈮

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