进展期宫颈癌放疗前子宫动脉化疗栓塞和灌注化疗价值研究
发布时间：2019-05-22 09:33
【摘要】：目的：进展期宫颈癌根治性放疗前子宫动脉化疗栓塞(uterine arterial chemoembolization, UACE)与子宫动脉灌注化疗(uterine arterial infusion chemotherapy, UAIC)对放疗远期疗效的影响方面的研究目前还很少,其对放疗并发症的远期影响则尚未见文献报道。本研究的目的是探讨根治性放疗前UACE与UAIC在进展期宫颈癌患者放疗中的价值及对放疗远期并发症的影响。方法：1研究对象追踪并收集2000年1月1日至2011年4月30间收治的735例原发性进展期宫颈癌患者,并按国际妇产科联合会(International gynecology and obstetrics department federation, FIGO)进行分期。2入选标准2.1原发性宫颈癌,病理类型包括鳞状细胞癌和腺癌；2.2既往无手术、化疗及其他任何抗肿瘤治疗史；2.3FIGO分期为Ⅱ-Ⅳa期；2.4无严重心肺和肾脏疾病,并且完成根治性放疗计划。3排除标准3.1 怀孕或妊娠患者；3.2同时或既往有其他恶性肿瘤病史；3.3根治性放疗计划没有完成(延长期超过7天)；3.4随访时间小于12个月或者死于其他非肿瘤性原因；3.5复发性宫颈癌。4统计学分析随访观察自放疗结束后开始,至患者死亡或最后一次随访时间截止,截止时间为2011年8月31日,随访采用门诊复查或电话随访方法进行。失访患者按截尾数处理。采用SPSS 15.0统计学软件进行分析。采用Kaplan-Meier法分析各组疾病相关生存率(disease-specific survival, DSS)、盆腔控制率(pelvic control, PC)和无远处转移生存率(distant metastases-free survival,MFS)。生存时间相关因素多变量分析采用COX回归分析。迟发性放射损伤按美国肿瘤放射治疗协作组和欧洲肿瘤治疗研究协作组(Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer, RTOG/EORTC)分级标准评价,并采用Binary logistic回归法分析迟发性放射损伤的相关危险因素。结果：735例原发性进展期宫颈癌患者FIGO分期如下：Ⅱ期299例,Ⅲ期359例,Ⅳa期77例。所有患者年龄24-80岁,中位年龄50岁。126例患者放疗前接受了UACE,103例患者放疗前接受了UAIC,余506例患者只行根治性放疗术(radical radiotherapy, RT)。所有患者1、2、5、8年DSS分别为94.5%、82.1%、50.2%、30.7%。与RT组比较,UAIC组DSS较高,但差别无统计学意义(P0.05)；UACE组DSS较低,差别有统计学意义(P0.05)。UAIC组、UACE组1、2年DSS较RT组稍高,但差异无统计学意义(所有P0.05),但随着放疗后时间的延长,UACE组的5、8年DSS明显降低(所有P0.05)。三组PC及MFS以UAIC组较高,UACE组较低,但差异无统计学意义(P0.05)。三组主要远期并发症(迟发性小肠损伤、迟发性直肠损伤、迟发性膀胱损伤)比较：前两个并发症发生率相近,差异无统计学意义,而迟发性膀胱损伤UACE组发生率较另外两组高2倍以上,差异具有统计学意义(11.1%vs 4.8% vs 4.2%,P0.05)。UACE是与迟发性膀胱损伤的强危险正相关因素(OR=2.869,P0.05)。结论：根治性放疗前行子宫UAIC对提高进展期宫颈癌患者的疗效及改善预后有积极作用。UACE显著降低患者的远期生存率,且是膀胱迟发性放疗损伤发生的强危险因素。
[Abstract]:Objective: To study the effect of advanced cervical cancer radical radiotherapy (UACE) and uterine artery perfusion chemotherapy (UAIC) on the long-term effect of radiotherapy, and the long-term effect on the complication of radiotherapy has not been reported in the literature. The purpose of this study is to explore the value of UACE and UAIC in the treatment of cervical cancer in the advanced stage of radiotherapy and the effect on the long-term complications of radiotherapy. Methods: A study of 735 patients with primary cervical cancer from January 1,2000 to April 30,2011 were collected and collected from January 1,2000 to April 30,2011. The type of pathology included squamous cell carcinoma and adenocarcinoma; 2.2 had a history of no prior surgery, chemotherapy and any other anti-tumor treatment; 2.3 FIGO was stage II-IV a; 2.4 had no severe cardiopulmonary and renal disease, and the radical radiotherapy plan was completed. 3.2 At the same time or with a history of other malignancies; 3.3 The radical radiotherapy plan was not completed (extended for more than 7 days); 3.4 follow-up time was less than 12 months or due to other non-neoplastic causes; 3.5 recurrent cervical cancer. The 4-day follow-up observation started after the end of the radiotherapy. At the end of the patient's death or the last follow-up time, the cutoff time was 31 August 2011 and the follow-up was performed using an out-of-patient review or a telephone follow-up method. The lost-to-follow-up patient was treated with a truncated mantissa. SPSS 15.0 statistical software was used for analysis. Kaplan-Meier method was used to analyze the disease-specific surface (DSS), pelvic control (PC) and distant metastasis-free survival (MFS). COX regression analysis was used for multivariate analysis of survival time-related factors. The delayed radiation injury was evaluated according to the classification criteria of the American Oncology Group and the European Organization for Research and Treatment of Cancer (RTCG/ EORTC), and the relevant risk factors of delayed radiation injury were analyzed by the Binary logistic regression method. Results: The staging of FIGO in 735 patients with primary stage cervical cancer was as follows:299 cases in stage 鈪，
本文编号：2482848
[Abstract]:Objective: To study the effect of advanced cervical cancer radical radiotherapy (UACE) and uterine artery perfusion chemotherapy (UAIC) on the long-term effect of radiotherapy, and the long-term effect on the complication of radiotherapy has not been reported in the literature. The purpose of this study is to explore the value of UACE and UAIC in the treatment of cervical cancer in the advanced stage of radiotherapy and the effect on the long-term complications of radiotherapy. Methods: A study of 735 patients with primary cervical cancer from January 1,2000 to April 30,2011 were collected and collected from January 1,2000 to April 30,2011. The type of pathology included squamous cell carcinoma and adenocarcinoma; 2.2 had a history of no prior surgery, chemotherapy and any other anti-tumor treatment; 2.3 FIGO was stage II-IV a; 2.4 had no severe cardiopulmonary and renal disease, and the radical radiotherapy plan was completed. 3.2 At the same time or with a history of other malignancies; 3.3 The radical radiotherapy plan was not completed (extended for more than 7 days); 3.4 follow-up time was less than 12 months or due to other non-neoplastic causes; 3.5 recurrent cervical cancer. The 4-day follow-up observation started after the end of the radiotherapy. At the end of the patient's death or the last follow-up time, the cutoff time was 31 August 2011 and the follow-up was performed using an out-of-patient review or a telephone follow-up method. The lost-to-follow-up patient was treated with a truncated mantissa. SPSS 15.0 statistical software was used for analysis. Kaplan-Meier method was used to analyze the disease-specific surface (DSS), pelvic control (PC) and distant metastasis-free survival (MFS). COX regression analysis was used for multivariate analysis of survival time-related factors. The delayed radiation injury was evaluated according to the classification criteria of the American Oncology Group and the European Organization for Research and Treatment of Cancer (RTCG/ EORTC), and the relevant risk factors of delayed radiation injury were analyzed by the Binary logistic regression method. Results: The staging of FIGO in 735 patients with primary stage cervical cancer was as follows:299 cases in stage 鈪，
本文编号：2482848
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