本文選題：宮頸癌 + 同步放化療��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]本研究旨在通過回顧性研究,分析ⅡB～ⅢB期宮頸癌患者的臨床特點(diǎn),比較同步放化療與新輔助化療后同步放化療兩種治療方式的遠(yuǎn)期療效及預(yù)后:比較單藥同步放化療與雙藥同步放化療的遠(yuǎn)期療效;比較同步放化療后行輔助化療與未行輔助化療的遠(yuǎn)期療效。[方法]收集昆明醫(yī)科大學(xué)第三附屬醫(yī)院2005年2月01日至2011年10月31日收治的經(jīng)病理組織學(xué)、影像學(xué)及婦科檢查確診的且隨訪資料完整的ⅡB～ⅢB期局部晚期宮頸癌患者171例。隨訪內(nèi)容包括:病史、婦科檢查、液基薄層細(xì)胞檢測、人乳頭瘤病毒檢查,大小便常規(guī)、腫瘤標(biāo)志物(CEA、SCC),B超,胸、腹、盆部CT或MRI、必要時(shí)腸鏡或膀胱鏡檢查。調(diào)查內(nèi)容包括:年齡、病理類型、腫塊類型、腫塊長徑、FIGO分期、淋巴結(jié)轉(zhuǎn)移、治療方式、放射治療技術(shù)及劑量、新輔助化療方案、同步化療方案、同步放化療后輔助化療方案、確診時(shí)間、死亡時(shí)間及最后一次隨訪時(shí)間。采用SPSS17. 0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的處理。[結(jié)果]1.同步放化療、靜脈新輔助化療后同步放化療兩種治療方式:兩組患者無論有無淋巴結(jié)轉(zhuǎn)移生存狀況無統(tǒng)計(jì)學(xué)差異(P 0.05)。ⅡB期患者同步組的生存狀況較新輔助組好,有統(tǒng)計(jì)學(xué)差異(P 0.05),其中ⅡB期有淋巴結(jié)轉(zhuǎn)移兩組生存狀況無統(tǒng)計(jì)學(xué)差異(P 0.05),但ⅡB期無淋巴結(jié)轉(zhuǎn)移時(shí),同步組較新輔助組生存狀況更好,有統(tǒng)計(jì)學(xué)差異(P 0.05)。Ⅲ期患者無論有無淋巴結(jié)轉(zhuǎn)移,兩組生存狀況無統(tǒng)計(jì)學(xué)差異(P 0.05)。單因素分析顯示,腫塊長徑、淋巴結(jié)轉(zhuǎn)移、同步化療方式、治療方式是影響宮頸癌患者預(yù)后的因素(P 0.05); COX多因素分析結(jié)果顯示,腫塊長徑、淋巴結(jié)轉(zhuǎn)移、同步化療方式、治療方式是患者預(yù)后的獨(dú)立影響因素。有淋巴結(jié)轉(zhuǎn)移患者,新輔助組局部復(fù)發(fā)率較同步組高,有顯著統(tǒng)計(jì)學(xué)差異(P 0.05);無淋巴結(jié)轉(zhuǎn)移患者新輔助組3-4級骨髓抑制發(fā)生比率明顯高于同步組,有顯著統(tǒng)計(jì)學(xué)差異(P 0.05) ; ⅡB期無淋巴結(jié)轉(zhuǎn)移患者新輔助組死亡率較同步組高,有顯著統(tǒng)計(jì)學(xué)差異(P 0.05) ; ⅡB及Ⅲ期有淋巴結(jié)轉(zhuǎn)移患者死亡率、局部復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率、近、遠(yuǎn)期毒副反應(yīng)兩組均無統(tǒng)計(jì)學(xué)差異(P 0.05) ; Ⅲ期無淋巴結(jié)轉(zhuǎn)移患者新輔助組局部復(fù)發(fā)率較同步組高,有統(tǒng)計(jì)學(xué)差異(P 0.05)。2.單藥同步放化療與雙藥同步放化療兩種同步化療方式:單藥組生存狀況好于雙藥組,有統(tǒng)計(jì)學(xué)差異(P 0.05);其中對于有淋巴結(jié)轉(zhuǎn)移、ⅡB期、Ⅲ期患者及新輔助化療后同步放化療患者,單藥同步放化療與雙藥同步放化療生存狀況無統(tǒng)計(jì)學(xué)差異(P 0.05);而無淋巴結(jié)轉(zhuǎn)移及同步放化療患者,單藥同步放化療生存狀況明顯較雙藥同步放化療好,有統(tǒng)計(jì)學(xué)差異(P 0.05)。3.同步放化療后行輔助化療與不行輔助化療兩種治療方式,兩組生存狀況無統(tǒng)計(jì)學(xué)差異(P 0.05)。而對于新輔助化療后同步放化療患者,未行輔助化療較行輔助化療生存狀況好,但無統(tǒng)計(jì)學(xué)差異(P 0.05)。[結(jié)論]1. ⅡB～ⅢB期宮頸鱗癌患者無論有無淋巴結(jié)轉(zhuǎn)移,同步放化療與新輔助化療后同步放化療的療效相當(dāng),但對于ⅡB期無淋巴結(jié)轉(zhuǎn)移者,新輔助化療導(dǎo)致患者生存狀況更差;腫塊長徑長、有淋巴結(jié)轉(zhuǎn)移、同步化療使用雙藥聯(lián)合、治療方式采用新輔助化療后同步放化療患者預(yù)后不良;新輔助化療增加同步放化療期間Ⅲ、Ⅳ級骨髓抑制的發(fā)生風(fēng)險(xiǎn),延長放療時(shí)間,導(dǎo)致局部復(fù)發(fā)風(fēng)險(xiǎn)增加,同時(shí)新輔助化療增加ⅡB期無淋巴結(jié)轉(zhuǎn)移患者的死亡風(fēng)險(xiǎn)。新輔助化療未給ⅡB～ⅢB期宮頸鱗癌患者帶來生存獲益。2. ⅡB～ⅢB期宮頸鱗癌患者單藥同步放化療較雙藥同步放化療生存狀況好,尤其對于無淋巴結(jié)轉(zhuǎn)移患者及同步放化療患者。3. ⅡB～ⅢB期宮頸鱗癌患者,無論有無淋巴結(jié)轉(zhuǎn)移,無論ⅡB期或ⅢB期,無論同步放化療還是新輔助化療后同步放化療,均未從輔助化療中獲益。
[Abstract]:[Objective] the purpose of this study was to analyze the clinical characteristics of cervical cancer patients in stage II B ~ III B by retrospective study and compare the long-term effect and prognosis of the two methods of synchronous radiotherapy and chemotherapy after concurrent chemo chemotherapy and neoadjuvant chemotherapy: compare the long-term effect of single drug concurrent chemoradiotherapy and double drug concurrent chemoradiotherapy; compare the adjuvant chemotherapy with concurrent chemoradiotherapy. [Methods] 171 cases of locally advanced cervical cancer, which were confirmed by histopathology, imaging and gynecologic examination, were admitted from 01 to October 31, 2011 February 2005 in Third Affiliated Hospital of Kunming Medical University, including 171 cases of locally advanced cervical cancer in stage II B to III B. The follow-up included the history of the disease, gynecologic examination, Liquid based thin layer cell detection, human papillomavirus examination, routine size and stool, tumor markers (CEA, SCC), B-ultrasound, chest, abdomen, and pelvic CT or MRI, enteroscopy or cystoscopy when necessary. Investigation includes age, pathological type, mass type, lump length, FIGO staging, lymph node metastasis, treatment, radiotherapy technique and dose, neoadjuvant Treatment regimen, synchronous chemotherapy regimen, adjuvant chemotherapy after concurrent chemoradiotherapy, time of diagnosis, time of death, and last follow-up time. Data were processed with SPSS17. 0 software. [results]1. synchronous radiotherapy and chemotherapy, neoadjuvant chemotherapy after intravenous neoadjuvant chemotherapy: no matter whether or not lymph node metastases exist in the two groups There was no statistical difference (P 0.05). The survival status of the patients with phase II B was better than that of the new adjuvant group (P 0.05), and there was no statistical difference between the two groups of lymph node metastases (P 0.05) in stage II B (P 0.05), but the survival of the synchronous group was better than that of the new adjuvant group (P 0.05). No matter whether or without lymph node metastasis, there was no statistical difference between the two groups (P 0.05). Single factor analysis showed that the length of the lump, lymph node metastasis, and synchronous chemotherapy were the factors affecting the prognosis of the cervical cancer patients (P 0.05); COX multiple factor analysis showed that the length of the lump, the lymph node metastasis, the mode of synchronous chemotherapy, and the treatment were treated. In patients with lymph node metastasis, the local recurrence rate of the neoadjuvant group was higher than that of the synchronous group (P 0.05). The rate of 3-4 grade myelosuppression in the neoadjuvant group without lymph node metastasis was significantly higher than that of the synchronous group (P 0.05), and the patients with no lymph node metastasis in phase II B stage had no lymph node metastasis. The mortality of the new adjuvant group was higher than that of the synchronous group (P 0.05). There was no statistical difference in the mortality of patients with lymph node metastasis in stage II B and stage III, the local recurrence rate, the distant metastasis rate, the near long-term toxicity and the side effects (P 0.05), and the local recurrence rate of the new adjuvant group with no lymph node metastasis in stage III was higher than that in the synchronous group, with a statistically poor statistical difference. Different (P 0.05).2. single drug concurrent chemo chemotherapy and double drug synchronous radiotherapy chemotherapy: the survival of the single drug group was better than the double drug group, with statistical difference (P 0.05). Among them, there were lymph node metastasis, stage II B, stage III patients and patients with concurrent chemo chemotherapy after neoadjuvant chemotherapy, single drug concurrent chemoradiotherapy and dual drug concurrent chemoradiotherapy There was no statistical difference (P 0.05); without lymph node metastasis and concurrent chemoradiotherapy, the survival of single drug concurrent chemoradiotherapy was better than that of double drug concurrent chemoradiotherapy. There were statistically significant differences (P 0.05).3. after.3. concurrent chemoradiotherapy with adjuvant chemotherapy and no adjuvant chemotherapy, and there was no statistical difference between the two groups (P 0.05). After adjuvant chemotherapy, adjuvant chemotherapy was better than adjuvant chemotherapy in patients without adjuvant chemotherapy, but there was no statistical difference (P 0.05). [conclusion]1. II B ~ III B cervical squamous cell carcinoma patients have no lymph node metastasis, synchronous radiotherapy and chemotherapy after neoadjuvant chemotherapy, but for patients without lymph node metastases in stage II B stage, it is new. Adjuvant chemotherapy leads to poorer survival, long diameter, lymph node metastasis, synchronous chemotherapy combined with double drugs, poor prognosis in patients with synchronous chemotherapy after neoadjuvant chemotherapy; new adjuvant chemotherapy increases the risk of stage III, grade IV bone marrow suppression, prolonging radiotherapy time, leading to local recurrent winds. Risk increases and neoadjuvant chemotherapy increases the risk of death in patients with phase II B without lymph node metastases. Neoadjuvant chemotherapy does not bring survival benefit to patients with stage II B to III B cervical squamous cell carcinoma. Single drug concurrent chemoradiotherapy in patients with.2. II B to B stage cervical squamous cell carcinoma is better than dual drug concurrent chemoradiotherapy, especially for patients without lymph node metastasis and synchronization. In patients with stage.3. II B ~ III B stage cervical squamous cell carcinoma, whether or not lymph node metastases, no matter in stage II B or stage III B, synchronous radiotherapy and chemotherapy after concurrent chemotherapy or neoadjuvant chemotherapy are not benefited from adjuvant chemotherapy.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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