ⅡB～ⅢB期宫颈鳞癌同步放化疗与新辅助化疗后同步放化疗的疗效及预后对比分析

发布时间：2018-06-24 11:09

本文选题：宫颈癌 + 同步放化疗　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]本研究旨在通过回顾性研究,分析ⅡB～ⅢB期宫颈癌患者的临床特点,比较同步放化疗与新辅助化疗后同步放化疗两种治疗方式的远期疗效及预后:比较单药同步放化疗与双药同步放化疗的远期疗效;比较同步放化疗后行辅助化疗与未行辅助化疗的远期疗效。[方法]收集昆明医科大学第三附属医院2005年2月01日至2011年10月31日收治的经病理组织学、影像学及妇科检查确诊的且随访资料完整的ⅡB～ⅢB期局部晚期宫颈癌患者171例。随访内容包括:病史、妇科检查、液基薄层细胞检测、人乳头瘤病毒检查,大小便常规、肿瘤标志物(CEA、SCC),B超,胸、腹、盆部CT或MRI、必要时肠镜或膀胱镜检查。调查内容包括:年龄、病理类型、肿块类型、肿块长径、FIGO分期、淋巴结转移、治疗方式、放射治疗技术及剂量、新辅助化疗方案、同步化疗方案、同步放化疗后辅助化疗方案、确诊时间、死亡时间及最后一次随访时间。采用SPSS17. 0统计软件进行数据的处理。[结果]1.同步放化疗、静脉新辅助化疗后同步放化疗两种治疗方式:两组患者无论有无淋巴结转移生存状况无统计学差异(P 0.05)。ⅡB期患者同步组的生存状况较新辅助组好,有统计学差异(P 0.05),其中ⅡB期有淋巴结转移两组生存状况无统计学差异(P 0.05),但ⅡB期无淋巴结转移时,同步组较新辅助组生存状况更好,有统计学差异(P 0.05)。Ⅲ期患者无论有无淋巴结转移,两组生存状况无统计学差异(P 0.05)。单因素分析显示,肿块长径、淋巴结转移、同步化疗方式、治疗方式是影响宫颈癌患者预后的因素(P 0.05); COX多因素分析结果显示,肿块长径、淋巴结转移、同步化疗方式、治疗方式是患者预后的独立影响因素。有淋巴结转移患者,新辅助组局部复发率较同步组高,有显著统计学差异(P 0.05);无淋巴结转移患者新辅助组3-4级骨髓抑制发生比率明显高于同步组,有显著统计学差异(P 0.05) ; ⅡB期无淋巴结转移患者新辅助组死亡率较同步组高,有显著统计学差异(P 0.05) ; ⅡB及Ⅲ期有淋巴结转移患者死亡率、局部复发率、远处转移率、近、远期毒副反应两组均无统计学差异(P 0.05) ; Ⅲ期无淋巴结转移患者新辅助组局部复发率较同步组高,有统计学差异(P 0.05)。2.单药同步放化疗与双药同步放化疗两种同步化疗方式:单药组生存状况好于双药组,有统计学差异(P 0.05);其中对于有淋巴结转移、ⅡB期、Ⅲ期患者及新辅助化疗后同步放化疗患者,单药同步放化疗与双药同步放化疗生存状况无统计学差异(P 0.05);而无淋巴结转移及同步放化疗患者,单药同步放化疗生存状况明显较双药同步放化疗好,有统计学差异(P 0.05)。3.同步放化疗后行辅助化疗与不行辅助化疗两种治疗方式,两组生存状况无统计学差异(P 0.05)。而对于新辅助化疗后同步放化疗患者,未行辅助化疗较行辅助化疗生存状况好,但无统计学差异(P 0.05)。[结论]1. ⅡB～ⅢB期宫颈鳞癌患者无论有无淋巴结转移,同步放化疗与新辅助化疗后同步放化疗的疗效相当,但对于ⅡB期无淋巴结转移者,新辅助化疗导致患者生存状况更差;肿块长径长、有淋巴结转移、同步化疗使用双药联合、治疗方式采用新辅助化疗后同步放化疗患者预后不良;新辅助化疗增加同步放化疗期间Ⅲ、Ⅳ级骨髓抑制的发生风险,延长放疗时间,导致局部复发风险增加,同时新辅助化疗增加ⅡB期无淋巴结转移患者的死亡风险。新辅助化疗未给ⅡB～ⅢB期宫颈鳞癌患者带来生存获益。2. ⅡB～ⅢB期宫颈鳞癌患者单药同步放化疗较双药同步放化疗生存状况好,尤其对于无淋巴结转移患者及同步放化疗患者。3. ⅡB～ⅢB期宫颈鳞癌患者,无论有无淋巴结转移,无论ⅡB期或ⅢB期,无论同步放化疗还是新辅助化疗后同步放化疗,均未从辅助化疗中获益。
[Abstract]:[Objective] the purpose of this study was to analyze the clinical characteristics of cervical cancer patients in stage II B ~ III B by retrospective study and compare the long-term effect and prognosis of the two methods of synchronous radiotherapy and chemotherapy after concurrent chemo chemotherapy and neoadjuvant chemotherapy: compare the long-term effect of single drug concurrent chemoradiotherapy and double drug concurrent chemoradiotherapy; compare the adjuvant chemotherapy with concurrent chemoradiotherapy. [Methods] 171 cases of locally advanced cervical cancer, which were confirmed by histopathology, imaging and gynecologic examination, were admitted from 01 to October 31, 2011 February 2005 in Third Affiliated Hospital of Kunming Medical University, including 171 cases of locally advanced cervical cancer in stage II B to III B. The follow-up included the history of the disease, gynecologic examination, Liquid based thin layer cell detection, human papillomavirus examination, routine size and stool, tumor markers (CEA, SCC), B-ultrasound, chest, abdomen, and pelvic CT or MRI, enteroscopy or cystoscopy when necessary. Investigation includes age, pathological type, mass type, lump length, FIGO staging, lymph node metastasis, treatment, radiotherapy technique and dose, neoadjuvant Treatment regimen, synchronous chemotherapy regimen, adjuvant chemotherapy after concurrent chemoradiotherapy, time of diagnosis, time of death, and last follow-up time. Data were processed with SPSS17. 0 software. [results]1. synchronous radiotherapy and chemotherapy, neoadjuvant chemotherapy after intravenous neoadjuvant chemotherapy: no matter whether or not lymph node metastases exist in the two groups There was no statistical difference (P 0.05). The survival status of the patients with phase II B was better than that of the new adjuvant group (P 0.05), and there was no statistical difference between the two groups of lymph node metastases (P 0.05) in stage II B (P 0.05), but the survival of the synchronous group was better than that of the new adjuvant group (P 0.05). No matter whether or without lymph node metastasis, there was no statistical difference between the two groups (P 0.05). Single factor analysis showed that the length of the lump, lymph node metastasis, and synchronous chemotherapy were the factors affecting the prognosis of the cervical cancer patients (P 0.05); COX multiple factor analysis showed that the length of the lump, the lymph node metastasis, the mode of synchronous chemotherapy, and the treatment were treated. In patients with lymph node metastasis, the local recurrence rate of the neoadjuvant group was higher than that of the synchronous group (P 0.05). The rate of 3-4 grade myelosuppression in the neoadjuvant group without lymph node metastasis was significantly higher than that of the synchronous group (P 0.05), and the patients with no lymph node metastasis in phase II B stage had no lymph node metastasis. The mortality of the new adjuvant group was higher than that of the synchronous group (P 0.05). There was no statistical difference in the mortality of patients with lymph node metastasis in stage II B and stage III, the local recurrence rate, the distant metastasis rate, the near long-term toxicity and the side effects (P 0.05), and the local recurrence rate of the new adjuvant group with no lymph node metastasis in stage III was higher than that in the synchronous group, with a statistically poor statistical difference. Different (P 0.05).2. single drug concurrent chemo chemotherapy and double drug synchronous radiotherapy chemotherapy: the survival of the single drug group was better than the double drug group, with statistical difference (P 0.05). Among them, there were lymph node metastasis, stage II B, stage III patients and patients with concurrent chemo chemotherapy after neoadjuvant chemotherapy, single drug concurrent chemoradiotherapy and dual drug concurrent chemoradiotherapy There was no statistical difference (P 0.05); without lymph node metastasis and concurrent chemoradiotherapy, the survival of single drug concurrent chemoradiotherapy was better than that of double drug concurrent chemoradiotherapy. There were statistically significant differences (P 0.05).3. after.3. concurrent chemoradiotherapy with adjuvant chemotherapy and no adjuvant chemotherapy, and there was no statistical difference between the two groups (P 0.05). After adjuvant chemotherapy, adjuvant chemotherapy was better than adjuvant chemotherapy in patients without adjuvant chemotherapy, but there was no statistical difference (P 0.05). [conclusion]1. II B ~ III B cervical squamous cell carcinoma patients have no lymph node metastasis, synchronous radiotherapy and chemotherapy after neoadjuvant chemotherapy, but for patients without lymph node metastases in stage II B stage, it is new. Adjuvant chemotherapy leads to poorer survival, long diameter, lymph node metastasis, synchronous chemotherapy combined with double drugs, poor prognosis in patients with synchronous chemotherapy after neoadjuvant chemotherapy; new adjuvant chemotherapy increases the risk of stage III, grade IV bone marrow suppression, prolonging radiotherapy time, leading to local recurrent winds. Risk increases and neoadjuvant chemotherapy increases the risk of death in patients with phase II B without lymph node metastases. Neoadjuvant chemotherapy does not bring survival benefit to patients with stage II B to III B cervical squamous cell carcinoma. Single drug concurrent chemoradiotherapy in patients with.2. II B to B stage cervical squamous cell carcinoma is better than dual drug concurrent chemoradiotherapy, especially for patients without lymph node metastasis and synchronization. In patients with stage.3. II B ~ III B stage cervical squamous cell carcinoma, whether or not lymph node metastases, no matter in stage II B or stage III B, synchronous radiotherapy and chemotherapy after concurrent chemotherapy or neoadjuvant chemotherapy are not benefited from adjuvant chemotherapy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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