同期放化疗的宫颈癌患者预后的多因素分析 - 第三军医大学学报.doc

同期放化疗的宫颈癌患者预后的多因素分析 岳成山1 王会霞1 高山1 李冬1 王佩1 余昌1 董学良1 张晶晶2 胡勇1* 陕西汉中，汉中市中心医院放疗科） 陕西汉中，汉中市中心医院肿瘤科) [摘要] 目的 目前以顺铂为基础的同放化疗已推荐为不能手术切除宫颈癌的标准治疗方式。本研究初步总结我科收治的宫颈癌同放化疗的治疗结果，统计分析影响预后的因素。方法：2006年1月1日-201年12月31日收治的170例IB1-IVA宫颈癌患者进入回顾性研究。化疗选用含顺铂的三个方案之一在放疗开始和放疗剂量达40Gy时给予，放疗采用外照射加192Ir高剂量率腔内后装照射，A点总剂量78-90Gy，B点总剂量46-56Gy。将患者的临床分期、盆腔及主动脉旁淋巴结情况、肿瘤大小 ( or 4 cm)、肿瘤消退情况、肿瘤标志物作为分析因子，用Cox回归对上述分析因子与无病进展期 (progression-free survival PFS)和总生存期(overall survival OS)的关系进行单因素和多因素分析。结果：单因素和多因素分析显示影响PFS的因素有：临床分期（p0.01），肿瘤大小（p0.01），肿瘤消退情况（p=0.01）和肿瘤标志物（p=0.01）。影响OS的因素为：临床分期(p=0.01)，肿瘤大小(p= 0.01)与肿瘤消退情况(p0.01)。 5年生存率IB1-IIA期患者为：91.5%，IIB期患者为：70.8%，III期患者为42.7%， IVA期患者为：20.5% 。结论：同放化疗治疗不能手术切除的的宫颈癌患者，影响预后的主要因素是临床分期、肿瘤大小和肿瘤消退情况。 [关键词]：宫颈癌；同期放化疗；预后因素 Multivariate Prognostic Analysis for Patients with Cervical Cancer after Concurrent Chemoradiation Yue Chenshan, Wan Huixia, Gao Shan, Li Dong, Wang Pei, Yu Chang, Dong Xueliang, Zhang Jingjing, Hu Hong (Department Of Radiotherapy,Central Hospital of Han Zhong City, Shan,xi Province) [Abstract] Objective Concurrent radiotherapy with concurrent cisplatin-based chemotherapy is recommended as standard treatment for unresectable cervical cancer. This study was undertaken to evaluate the outcomes and the prognostic factors for cervical cancer after chemoradiation. Methods A total of 170 patients with stage IB1–IVA who were treated in our hospital between January 2006 and December 2010 were reviewed and analyzed. All patients received 3D-CRT radiotherapy with one of three regimens of cisplatin-based chemotherapy concurrently and 192Ir high-dose rate brachytherapy. Chemotherapy at the beginning of radiotherapy, and when the radiation dose escalated to 40Gy. The total dose of point A range 78-90Gy and point B range 46-56Gy. Sage, lymph node status, tumor size(or4 cm), clinical response, tumor marker were used as analysis factors for Cox regression univariate and multivariate analyses.Results Stage （p0.01）, tumor size （p0.01）, clinical response（p=0.01）, and tum