進(jìn)展期宮頸癌放療前子宮動脈化療栓塞和灌注化療價值研究
發(fā)布時間：2019-05-22 09:33
【摘要】：目的：進(jìn)展期宮頸癌根治性放療前子宮動脈化療栓塞(uterine arterial chemoembolization, UACE)與子宮動脈灌注化療(uterine arterial infusion chemotherapy, UAIC)對放療遠(yuǎn)期療效的影響方面的研究目前還很少,其對放療并發(fā)癥的遠(yuǎn)期影響則尚未見文獻(xiàn)報道。本研究的目的是探討根治性放療前UACE與UAIC在進(jìn)展期宮頸癌患者放療中的價值及對放療遠(yuǎn)期并發(fā)癥的影響。方法：1研究對象追蹤并收集2000年1月1日至2011年4月30間收治的735例原發(fā)性進(jìn)展期宮頸癌患者,并按國際婦產(chǎn)科聯(lián)合會(International gynecology and obstetrics department federation, FIGO)進(jìn)行分期。2入選標(biāo)準(zhǔn)2.1原發(fā)性宮頸癌,病理類型包括鱗狀細(xì)胞癌和腺癌；2.2既往無手術(shù)、化療及其他任何抗腫瘤治療史；2.3FIGO分期為Ⅱ-Ⅳa期；2.4無嚴(yán)重心肺和腎臟疾病,并且完成根治性放療計劃。3排除標(biāo)準(zhǔn)3.1 懷孕或妊娠患者；3.2同時或既往有其他惡性腫瘤病史；3.3根治性放療計劃沒有完成(延長期超過7天)；3.4隨訪時間小于12個月或者死于其他非腫瘤性原因；3.5復(fù)發(fā)性宮頸癌。4統(tǒng)計學(xué)分析隨訪觀察自放療結(jié)束后開始,至患者死亡或最后一次隨訪時間截止,截止時間為2011年8月31日,隨訪采用門診復(fù)查或電話隨訪方法進(jìn)行。失訪患者按截尾數(shù)處理。采用SPSS 15.0統(tǒng)計學(xué)軟件進(jìn)行分析。采用Kaplan-Meier法分析各組疾病相關(guān)生存率(disease-specific survival, DSS)、盆腔控制率(pelvic control, PC)和無遠(yuǎn)處轉(zhuǎn)移生存率(distant metastases-free survival,MFS)。生存時間相關(guān)因素多變量分析采用COX回歸分析。遲發(fā)性放射損傷按美國腫瘤放射治療協(xié)作組和歐洲腫瘤治療研究協(xié)作組(Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer, RTOG/EORTC)分級標(biāo)準(zhǔn)評價,并采用Binary logistic回歸法分析遲發(fā)性放射損傷的相關(guān)危險因素。結(jié)果：735例原發(fā)性進(jìn)展期宮頸癌患者FIGO分期如下：Ⅱ期299例,Ⅲ期359例,Ⅳa期77例。所有患者年齡24-80歲,中位年齡50歲。126例患者放療前接受了UACE,103例患者放療前接受了UAIC,余506例患者只行根治性放療術(shù)(radical radiotherapy, RT)。所有患者1、2、5、8年DSS分別為94.5%、82.1%、50.2%、30.7%。與RT組比較,UAIC組DSS較高,但差別無統(tǒng)計學(xué)意義(P0.05)；UACE組DSS較低,差別有統(tǒng)計學(xué)意義(P0.05)。UAIC組、UACE組1、2年DSS較RT組稍高,但差異無統(tǒng)計學(xué)意義(所有P0.05),但隨著放療后時間的延長,UACE組的5、8年DSS明顯降低(所有P0.05)。三組PC及MFS以UAIC組較高,UACE組較低,但差異無統(tǒng)計學(xué)意義(P0.05)。三組主要遠(yuǎn)期并發(fā)癥(遲發(fā)性小腸損傷、遲發(fā)性直腸損傷、遲發(fā)性膀胱損傷)比較：前兩個并發(fā)癥發(fā)生率相近,差異無統(tǒng)計學(xué)意義,而遲發(fā)性膀胱損傷UACE組發(fā)生率較另外兩組高2倍以上,差異具有統(tǒng)計學(xué)意義(11.1%vs 4.8% vs 4.2%,P0.05)。UACE是與遲發(fā)性膀胱損傷的強危險正相關(guān)因素(OR=2.869,P0.05)。結(jié)論：根治性放療前行子宮UAIC對提高進(jìn)展期宮頸癌患者的療效及改善預(yù)后有積極作用。UACE顯著降低患者的遠(yuǎn)期生存率,且是膀胱遲發(fā)性放療損傷發(fā)生的強危險因素。
[Abstract]:Objective: To study the effect of advanced cervical cancer radical radiotherapy (UACE) and uterine artery perfusion chemotherapy (UAIC) on the long-term effect of radiotherapy, and the long-term effect on the complication of radiotherapy has not been reported in the literature. The purpose of this study is to explore the value of UACE and UAIC in the treatment of cervical cancer in the advanced stage of radiotherapy and the effect on the long-term complications of radiotherapy. Methods: A study of 735 patients with primary cervical cancer from January 1,2000 to April 30,2011 were collected and collected from January 1,2000 to April 30,2011. The type of pathology included squamous cell carcinoma and adenocarcinoma; 2.2 had a history of no prior surgery, chemotherapy and any other anti-tumor treatment; 2.3 FIGO was stage II-IV a; 2.4 had no severe cardiopulmonary and renal disease, and the radical radiotherapy plan was completed. 3.2 At the same time or with a history of other malignancies; 3.3 The radical radiotherapy plan was not completed (extended for more than 7 days); 3.4 follow-up time was less than 12 months or due to other non-neoplastic causes; 3.5 recurrent cervical cancer. The 4-day follow-up observation started after the end of the radiotherapy. At the end of the patient's death or the last follow-up time, the cutoff time was 31 August 2011 and the follow-up was performed using an out-of-patient review or a telephone follow-up method. The lost-to-follow-up patient was treated with a truncated mantissa. SPSS 15.0 statistical software was used for analysis. Kaplan-Meier method was used to analyze the disease-specific surface (DSS), pelvic control (PC) and distant metastasis-free survival (MFS). COX regression analysis was used for multivariate analysis of survival time-related factors. The delayed radiation injury was evaluated according to the classification criteria of the American Oncology Group and the European Organization for Research and Treatment of Cancer (RTCG/ EORTC), and the relevant risk factors of delayed radiation injury were analyzed by the Binary logistic regression method. Results: The staging of FIGO in 735 patients with primary stage cervical cancer was as follows:299 cases in stage 鈪，
本文編號：2482848
[Abstract]:Objective: To study the effect of advanced cervical cancer radical radiotherapy (UACE) and uterine artery perfusion chemotherapy (UAIC) on the long-term effect of radiotherapy, and the long-term effect on the complication of radiotherapy has not been reported in the literature. The purpose of this study is to explore the value of UACE and UAIC in the treatment of cervical cancer in the advanced stage of radiotherapy and the effect on the long-term complications of radiotherapy. Methods: A study of 735 patients with primary cervical cancer from January 1,2000 to April 30,2011 were collected and collected from January 1,2000 to April 30,2011. The type of pathology included squamous cell carcinoma and adenocarcinoma; 2.2 had a history of no prior surgery, chemotherapy and any other anti-tumor treatment; 2.3 FIGO was stage II-IV a; 2.4 had no severe cardiopulmonary and renal disease, and the radical radiotherapy plan was completed. 3.2 At the same time or with a history of other malignancies; 3.3 The radical radiotherapy plan was not completed (extended for more than 7 days); 3.4 follow-up time was less than 12 months or due to other non-neoplastic causes; 3.5 recurrent cervical cancer. The 4-day follow-up observation started after the end of the radiotherapy. At the end of the patient's death or the last follow-up time, the cutoff time was 31 August 2011 and the follow-up was performed using an out-of-patient review or a telephone follow-up method. The lost-to-follow-up patient was treated with a truncated mantissa. SPSS 15.0 statistical software was used for analysis. Kaplan-Meier method was used to analyze the disease-specific surface (DSS), pelvic control (PC) and distant metastasis-free survival (MFS). COX regression analysis was used for multivariate analysis of survival time-related factors. The delayed radiation injury was evaluated according to the classification criteria of the American Oncology Group and the European Organization for Research and Treatment of Cancer (RTCG/ EORTC), and the relevant risk factors of delayed radiation injury were analyzed by the Binary logistic regression method. Results: The staging of FIGO in 735 patients with primary stage cervical cancer was as follows:299 cases in stage 鈪，
本文編號：2482848
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