伴有盆腔淋巴结转移的宫颈癌新辅助化疗联合放化疗临床疗效及预后因素分析

张慧慧; 王蓓蓓; 张献文; 王丽华; 魏丽; 李艳; 张競

doi:10.16766/j.cnki.issn.1674-4152.002176

伴有盆腔淋巴结转移的宫颈癌新辅助化疗联合放化疗临床疗效及预后因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002176

1.
蚌埠医学院第一附属医院肿瘤妇科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院放疗科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0384

详细信息

通讯作者:
张競，E-mail：zhangjing1179@163.com

中图分类号: R737.33 R730.58
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- 文章访问数: 155
- HTML全文浏览量: 93
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-22
- 网络出版日期: 2022-02-15

Treatment effect and analysis of prognostic factors of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy for advanced cervical cancer with pelvic lymph node metastasis

1.
Department of Gynecological Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的针对伴有盆腔淋巴结转移的中晚期宫颈鳞状细胞癌患者，回顾性分析新辅助化疗联合根治性同步放化疗及巩固化疗的临床疗效及预后影响因素。方法选取2015年1月—2018年1月就诊于蚌埠医学院第一附属医院的67例伴有盆腔淋巴结转移的宫颈鳞癌患者，分期为ⅡA~ⅢB期，研究组27例患者接受新辅助化疗联合同步放化疗及巩固化疗，对照组40例患者接受同步放化疗联合巩固化疗。观察2组患者的临床疗效、不良反应，用Kaplan-Meier法绘制的生存曲线，log-rank法比较预后，通过Cox回归模型进行多因素分析。结果在客观缓解率及3年无进展生存率方面，研究组明显高于对照组(88.9% vs.67.5%, P < 0.05；70.4% vs.45.0%, P < 0.05)。在3年总生存率方面，研究组稍高于对照组，但差异无统计学意义(77.8% vs.65.0%, P>0.05)，2组在血液系统、消化系统、泌尿系统方面出现不良反应的情况，差异无统计学意义(均P>0.05)。Cox模型多因素分析显示，肿瘤分期、淋巴结转移部位是OS的独立影响因素，肿瘤分期、淋巴结转移部位、新辅助化疗是PFS的独立影响因素。结论对于伴有盆腔淋巴结转移的中晚期宫颈癌患者，新辅助化疗联合同步放化疗，再进行巩固化疗是一种有效的治疗方式，疗效优于直接进行同步放化疗后巩固化疗，且相关不良反应能够耐受。
- 新辅助化疗 /
- 同步放化疗 /
- 宫颈癌 /
- 淋巴结转移
Abstract: Objective To evaluate the efficacy and prognostic factors of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy of advanced cervical cancer patients with pelvic lymph node metastasis. Methods A total of 67 cases of advanced cervical cancer patients with pelvic lymph node metastasis (ⅡA - ⅢB) were collected in our hospital from January 2015 to January 2018. They were assigned to two groups: the treatment group (n=27) was treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy, whilst the control group (n=40) only received concurrent chemoradiotherapy and consolidation chemotherapy. The clinical effect and related prognostic factors were observed. The survival curve was established via the Kaplan-Meier method. The survival of the two groups was compared via log-rank test. Multivariate Cox regression analysis was used for multivariate analysis. Results Compared with the control group, the treatment group showed improved objective response rate (88.9% vs. 67.5%, P < 0.05) and 3-year progression-free survival (PFS) rate (70.4% vs. 45.0%, P < 0.05). No significant difference was observed in the 3-year overall survival (OS) rate between the two groups (77.8% vs. 65.0%, P>0.05). Bone marrow inhibition, gastrointestinal reactions and urinary system reactions were not significantly different in both groups (all P>0.05). Multivariate analysis showed that FIGO stage and location of lymph node metastasis were independent prognostic factors of OS. FIGO stage, location of lymph node metastasis and neoadjuvant chemotherapy were independent prognostic factors of PFS. Conclusion The addition of neoadjuvant chemotherapy to concurrent chemoradiotherapy and consolidation chemotherapy is superior to concurrent chemoradiotherapy and consolidation chemotherapy for advanced cervical cancer with pelvic lymph node metastasis. Moreover, the adverse reactions can be tolerated.
- Neoadjuvant chemotherapy /
- Concurrent chemoradiotherapy /
- Cervical cancer /
- Lymph node metastasis

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图 1 2组宫颈癌患者总生存率曲线

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图 2 2组宫颈癌患者无进展生存率曲线

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表 1 2组宫颈癌患者的临床疗效

组别	例数	完全缓解[例(%)]	部分缓解[例(%)]	疾病稳定[例(%)]	疾病进展[例(%)]	客观缓解率(%)
研究组	27	21(77.8)	3(11.1)	2(7.4)	1(3.7)	88.9(24/27)
对照组	40	23(57.5)	4(10.0)	8(20.0)	5(12.5)	67.5(27/40)
注：2组客观缓解率比较，χ²=4.057,P=0.044。

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表 2 影响宫颈癌患者预后的单因素分析

项目	例数	3年总生存率(%)	χ²值	P值	3年无进展生存率(%)	χ²值	P值
年龄(岁)			0.139	0.709		0.282	0.595
< 50	30	73.3(22/30)			60.0(18/30)
≥50	37	67.6(25/37)			51.4(19/37)
肿瘤直径(cm)			1.795	0.180		2.807	0.094
< 4	24	79.2(19/24)			62.5(15/24)
≥4	43	65.1(28/43)			51.2(22/43)
淋巴结转移部位			4.889	0.027		4.216	0.040
盆腔非髂总	50	76.0(38/50)			60.0(30/50)
髂总	17	52.9(9/17)			41.2(7/17)
分期			8.177	0.004		4.026	0.045
ⅡA~ⅡB	39	79.5(31/39)			64.1(25/39)
ⅢA~ⅢB	28	57.1(16/28)			42.9(12/28)
新辅助化疗			0.869	0.351		4.010	0.045
是	27	77.8(21/27)			70.4(19/27)
否	40	65.0(26/40)			45.0(18/40)

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表 3 影响宫颈癌患者预后的多因素分析

因素	B	SE	Wald χ²	P值	HR值	95%CI
总生存率
分期	-1.044	0.374	7.774	0.005	0.352	0.169~0.733
淋巴结转移部位	-0.876	0.394	4.941	0.026	0.416	0.192~0.902
无进展生存率
分期	-0.666	0.318	4.396	0.036	0.514	0.276~0.958
淋巴结转移部位	-0.819	0.346	5.621	0.018	0.441	0.224~0.868
新辅助化疗	-0.773	0.345	5.033	0.025	0.461	0.235~0.907

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表 4 2组宫颈癌患者不良反应发生情况比较[例(%)]

组别	例数	血液系统		消化道反应		泌尿系统反应
组别	例数	1~2级	3~4级	1~2级	3~4级	1~2级	3~4级
研究组	27	16(59.3)	10(37.0)	11(40.7)	3(11.1)	4(14.8)	0(0.0)
对照组	40	20(50.0)	9(22.5)	19(47.5)	5(12.5)	8(20.0)	0(0.0)
χ²值		0.556	1.677	0.298	< 0.001	0.048
P值		0.456	0.195	0.585	0.999	0.827

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