摘要
目的：探讨辅助化疗对低危型（指不具有盆腔淋巴结转移、宫旁组织受累、手术切缘阳性、原发肿瘤大（＆gt;4 cm）、宫颈间质深层浸润以及淋巴脉管浸润）宫颈癌患者预后的影响。方法对208例低危型宫颈癌患者的临床资料进行回顾性研究，分析辅助化疗的指征及其与复发和生存的关系。结果208例患者的中位随访时间为73个月，总复发率为4.8%，5年总生存率为96.0%。69例术后接受了方案为Taxol＋Cisplatin的辅助化疗，中位疗程数2.5疗程（2~4疗程）。组织学Ⅲ级的患者接受辅助化疗的比例为50/114，Ⅰ~Ⅱ级者为19/94，单因素分析显示肿瘤的组织学分级与是否接受了辅助化疗显著相关（P＆lt;0.001）。114例组织学Ⅲ级的患者中，辅助化疗组复发率为4.0%，5年总生存率97.0%，而未接受辅助化疗组复发率为4.7%，5年总生存率95.0%，两组复发率及5年总生存率无显著差异（all, P＆gt;0.05）。208例患者中肿瘤≤2 cm的患者复发率为1.1%，5年总生存率100%，而肿瘤＆gt;2 cm的患者复发率为7.5%，5年总生存率为93.0%，肿瘤大小与患者复发率、5年总生存率显著相关（P=0.034，P=0.042）。139例仅接受了手术治疗的患者中，组织学分级、年龄、FIGO分期、大体类型、肿瘤大小、组织学类型与复发和5年生存率均无显著相关（all, P＆gt;0.05）。结论宫颈癌的组织学分级作为低危型患者术后辅助化疗的指征依据不足，术后根据组织学分级给予的辅助化疗亦无益于减少复发或改善远期生存。
Objective To investigate the effect of adjuvant chemotherapy on the prognosis of patients with low-risk cervical cancer （without pelvic lymph node metastasis, parametrial involvement, positive surgical margin, primary tumor size＆gt;4 cm, deep cervical stromal invasion, or lymph-vascular space invasion）. Methods The clinical data of 208 patients with low-risk cervical cancer were studied retrospectively to analyze the indications of adjuvant chemotherapy and its relationship with tumor recurrence and the patients＆#39; survival. Results The median follow-up time of the cohort was 73 months. The overall tumor recurrence rate was 4.8%and the total 5-year survival rate of the patients was 96.0%. Sixty-nine of the patients received adjuvant chemotherapy （Taxol＋Cisplatin） after the operation with a median of 2.5 （2-4） courses. Univariate analysis showed that the histological tumor grade was significantly associated with adjuvant chemotherapy （P＆lt;0.001）. In the 114 grade III patients, 50 received adjuvant chemotherapy as compared with 19 in the 94 grade I-II patients. Among the grade III patients, no significant differences was found in the overall survival rate （97.0%vs 95.0%） or tumor recurrence rate （4.0%vs 4.7%） rate between the patients with adjuvant chemotherapy and those without. The tumor size （2 cm or less vs＆gt;2 cm） was significantly associated with tumor recurrence rate （1.1%vs 7.5%, P=0.034） and the overall 5-year survival rate （100.0%vs 93.0%, P=0.034） in the 208 patients. In the 139 patients receiving only surgical treatment, the tumor recurrence and 5-year survival rates were not significantly correlated with the histologic grade, age, FIGO staging, gross type, tumor size or histologic type. Conclusion There has been no sufficient evidence to support the prescription of postoperative adjuvant chemotherapy for low-risk cervical cancer based on histological grading of the tumor, which may not help in reducing tumor recurrence or improving the long-term survival of the postoperative patients.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2014年第3期401-405,共5页
Journal of Southern Medical University
基金
国家自然科学基金(81172484)~~
关键词
宫颈癌
化疗
组织学分级
cervical cancer
chemotherapy
histological grade
作者简介
孙菲，在读硕士研究生，电话：020—87343105，E．mail：sffnyd521@163．com
通信作者：熊樱，硕士，副主任医师，硕士研究生导师，电话：020·87343105，E-mail：tdken999@163．com
