摘要
目的探讨附件受累的Ⅲa期子宫内膜样腺癌患者术后放射治疗的临床疗效。方法选取2007年1月至2016年12月间福建医科大学附属肿瘤医院收治的98例附件受累的Ⅲa期子宫内膜样腺癌患者,根据术后是否放疗分为放疗组60例和无放疗组38例,比较两组患者的临床治疗效果及不良反应。结果患者5年总生存率为77.6%,5年无病生存时间(DFS)为63.7%。放疗组5年总生存时间(OS)为85.7%,无放疗组为63.8%,差异有统计学意义(P=0.04)。放疗组5年DFS为67.5%,无放疗组为57.4%,差异无统计学意义(P=0.61)。COX多因素分析显示,深肌层受侵和术后放疗是影响患者OS的独立因素,相比无放疗患者,术后接受放疗的患者总体生存更好,差异有统计学意义(P=0.02)。>60岁、肿瘤Ⅲ级、深肌层受侵是影响患者DFS的独立因素,术后放疗与DFS无关,差异无统计学意义(P=0.47)。放疗组患者4例出现Ⅲ度放射性直肠炎,4例出现Ⅲ度下肢水肿。1例单纯化疗患者治疗后7个月出现肠梗阻。治疗中和治疗后发生的不良反应经对症治疗后均好转或治愈。放疗组患者未出现Ⅳ度放射性膀胱炎和放射性直肠炎。患者死亡26例。放疗组患者局部复发8例,远处转移10例,局部复发+远处转移3例,局部复发率18.3%(11例)。无放疗组局部复发6例,远处转移1例,局部复发+远处转移6例,局部复发率31.6%(12例),两组患者复发率比较,差异无统计学意义(P=0.13)。结论对附件受累的Ⅲa期子宫内膜样腺癌术后深肌层受侵的患者,术后采用放疗治疗,可提高疗效,可能使生存获益,但仍需大样本病例证实。
Objective To retrospectively analyze the efficacy of postoperative radiotherapy for stageⅢa endometrioid adenocarcinoma with adnexal involvement.Methods From January 2007 to December2016,98 patients with stageⅢa endometrial adenocarcinoma with adnexal involvement were selected.They were categorized into a radiotherapy group(60 patients)and a non-radiotherapy group(38 patients).Clinical efficacy and adverse reactions were compared between the two groups.Results The 5-year overall survival(OS)was 77.6%.The 5-year disease-free survival(DFS)was 63.7%.The 5-year OS was 85.7%in the radiotherapy group and 63.8%in the non-radiotherapy group(P<0.05).The 5-year DFS was67.5%in the radiotherapy group and 57.4%in the non-radiotherapy group(P>0.05).COX multivariate analysis showed deep muscle invasion and postoperative radiotherapy were independent factors influencing OS.In general,the survival was better in the radiotherapy group compared with the non-radiotherapy group(P<0.05).What’s more,over the age of 60,stageⅢcancer and deep muscle invasion were independent factors influencing DFS.However,there was no association between postoperative radiotherapy and DFS(P>0.05).GradeⅢradiation proctitis occurred in 4 patients,gradeⅢlower limb edema occurred in 4 patients and intestinal obstruction occurred in 1 patient receiving single radiotherapy at 7 months after the treatment.Adverse reactions were relieved or cured after symptomatic treatment.No gradeⅣradiation cystitis and radiation proctitis was discovered in the radiotherapy group.Twenty-six patients died.Local recurrence occurred in 8 patients,distant metastasis occurred in 10 patients and concurrent local recurrence and distant metastasis occurred in 3 patients with a local recurrence rate of 18.3%(11 patients)in the radiotherapy group.In the non-radiotherapy group,Local recurrence occurred in 6 patients,distant metastasis occurred in 1 patient and concurrent local recurrence and distant metastasis occurred in 6 patients with a local recurrence rate of 31.6%(12 patients).There was no significant difference in the recurrence rate between the two groups.Conclusion Postoperative radiotherapy can improve therapeutic effect and may benefit the survival in patients with stageⅢa endometrioid adenocarcinoma with adnexal involvement but largesample studies are needed to confirm this conclusion.
作者
李慧灵
李秀华
杨梅春
林慧娟
谢榕
LI Hui-ling;LI Xiu-hua;YAN Mei-chun;LIN Hui-juan;XIE Rong(Department of Gynecologic Oncology,Fujian Cancer Hospital Affiliated to Fujian Medical University,Fuzhou 350014,China)
出处
《中国肿瘤临床与康复》
2021年第11期1321-1325,共5页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
子宫内膜肿瘤
全面手术分期
放射治疗
药物疗法
Endometrial neoplasms
Thorough surgical staging
Radiotherapy
Drug therapy
作者简介
李慧灵,女,副主任医师,主要从事妇科恶性肿瘤治疗专业。
