摘要
目的探讨中晚期（Ⅱb～Ⅳa期）子宫颈鳞癌同步放化疗的疗效及远处转移的影响因素。方法收集2006年1月至2010年12月于大连医科大学附属第二医院接受同步放化疗的118例中晚期子宫颈鳞癌患者的临床病理资料,患者的中位年龄为48岁（23～70岁）；临床分期：按国际妇产科联盟（FIGO）2009年的分期标准，Ⅱb期56例，Ⅲa期6例，Ⅲb期52例，Ⅳa期4例；肿瘤直径：〉4 cm者55例，≤4 cm者63例；盆腔淋巴结转移：有转移者为35例，无转移者83例；治疗前血红蛋白（Hb）水平：≤110 g/L者为40例，〉110 g/L者为78例；治疗前血清鳞状细胞癌抗原（SCC-Ag）水平：〉1.5μg/L者91例，≤1.5μg/L者27例；治疗后SCC-Ag水平：〉1.5μg/L者34例，≤1.5μg/L者84例。回顾性分析子宫颈鳞癌患者同步放化疗后的疗效及副反应，并对影响同步放化疗后远处转移的因素进行分析。结果（1）118例患者中，复发37例，复发率为31.4%（37/118）；其中局部复发者13例，远处转移者19例，局部复发和远处转移均有者5例。患者的5年总生存率为64.0%，5年无远处转移生存率为78.8%。急性副反应：2例发生Ⅲ级胃肠道反应（主要为腹泻），20例发生Ⅲ～Ⅳ度骨髓抑制；晚期放疗反应：5例发生Ⅲ～Ⅳ级胃肠道反应，2例发生Ⅲ或Ⅳ级膀胱反应。（2）单因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后血清SCC-Ag水平、治疗前Hb水平、盆腔淋巴结转移明显相关（P〈0.05）；多因素分析显示，中晚期子宫颈鳞癌患者同步放化疗后远处转移与临床分期、治疗后SCC-Ag水平、盆腔淋巴结转移明显相关（P〈0.05）。结论中晚期子宫颈鳞癌患者同步放化疗的疗效满意，且安全性好。同步放化疗后远处转移的影响因素包括临床分期、治疗后血清SCC-Ag水平和盆腔淋巴结转移，对这些患者需要考虑新的治疗策略来控制远处转移。
Objective To evaluate the outcomes and prognostic factors of distant metastasis in patients with advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy （CCRT）. Methods A total of 118 patients with International Federation of Gynecology and Obstetrics （FIGO, 2009 version） stageⅡb-Ⅳa cervical squamous cell carcinoma treated with CCRT between 2006 and 2010 in the Second Affiliated Hospital of Dalian Medical University were analyzed. Their median age was 48 years （range, 23-70 years）. FIGO stages were as follows：Ⅱb stage 56 cases,Ⅲa stage 6 cases,Ⅲb stage 52 cases, andⅣa stage 4 cases. Of the all patients, 55 cases showed bulkly tumor （tumor size〉4 cm） and 35 cases were pelvic lymph node positive. Forty patients had pretreatment hemoglobin （Hb） levels no greater than 110 g/L. Patients with elevated squamous cell carcinoma antigen （SCC-Ag） 〉1.5 μg/L before CCRT and at one month after CCRT were 91 cases and 34 cases, respectively. Kaplan-Meier method was used to estimate survival. For the analysis of prognostic factors affecting distant metastasis, log-rank test was used for univariate analysis, and Cox proportional hazard model was used for multivariate analysis. Results Thirty-seven patients were diagnosed with recurrence, 19 cases of whom developed distant metastasis, 13 cases developed loco-regional recurrence and 5 cases had both distant and loco-regional recurrence. The＆amp;nbsp;5-year overall survival rates and distant disease-free survival of all patients were 64.0% and 78.8%, respectively. Two patients had grade 3 acute gastrointestinal toxicity （mainly diarrhea） and 20 cases had grade 3 to 4 hematologic toxicity. Seven patients experienced grade 3 to 4 late toxicity, 5 cases of them were gastrointestinal and 2 cases were genitourinary toxicity. Univariate analysis showed that FIGO stages, SCC-Ag level at one month after treatment, pretreatment hemoglobin level, and pelvic lymph node metastasis were significantly correlated with distant metastasis （all P〈0.05）. Multivariate analysis showed that FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis were independent prognostic factors for distant metastasis （all P〈0.05）. Conclusions For stageⅡb-Ⅳa cervical squamous cell carcinoma, the regimen of CCRT was efficacious and safe. The predictive factors for distant metastasis in patients withⅡb-Ⅳa stage squamous cell carcinoma of cervix treated with CCRT included FIGO stage, SCC-Ag level at one month after treatment, and pelvic lymph node metastasis. New treatment strategies should be considered to control distant metastasis for these patients.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2015年第2期125-130,共6页
Chinese Journal of Obstetrics and Gynecology
关键词
宫颈肿瘤
癌
鳞状细胞
化放疗
淋巴转移
肿瘤分期
抗原
肿瘤
Uterine cervical neoplasms
Carcinoma,squamous cell
Chemoradiotherapy
Lymphatic metastasis
Neoplasm staging
Antigens,neoplasm
作者简介
通信作者：马瑞兰，Email：maruilan2000@163．com
