摘要目的 比较宫颈癌术前同期放化疗加根治术与根治性放疗同期化疗的临床疗效及远期不良反应.方法 回顾分析2004-2011年收治的243例ⅡB期宫颈癌患者,121例术前同期放化疗加根治术(放化疗手术组),122例根治性放疗同期化疗(放化疗组),化疗方案为顺铂40 mg/m2·周.Kaplan-Meier法计算生存率等并Logrank法检验,Cox法多因素预后分析.结果 放化疗手术组、放化疗组随访率均为100％,随访时间满3年样本数分别为34、33例.放化疗手术组与放化疗组3年无进展生存率(PFS)为91.5％与82.0％ (P=0.013),总生存率(OS)为95.5％与89.2％(P=0.085),局控率为96.7％与93.4％ (P =0.375).肿瘤直径(≥6 cm)、年龄(≤35岁)为放化疗手术组PFS预后因素(P =0.033、0.037).病理类型(非鳞癌)、肿瘤直径(≥6 cm)为放化疗组PFS预后因素(P=0.013、0.002),其中肿瘤直径(≥6 cm)也是OS预后因素(P=0.007).放化疗手术组下肢水肿发生率较高(P =0.000),放化疗组放射性肠炎发生率较高(P =0.000).结论 初步结果表明术前同期放化疗加根治术能获得较好预后,肿瘤直径为两个组共同的PFS预后因素.

abstractsObjective To compare concurrent radiochemotherapy (CRCT) followed by radical surgery and radical radiotherapy (RT) with concurrent weekly cisplatin in terms of survival rates and longterm toxicities in patients with FIGO stage ⅡB cervical cancer.Methods A retrospective analysis was performed on 243 patients with FIGO stage ⅡB cervical cancer who were admitted to our hospital from November 2004 to November 2011.Of the 243 patients,121 patients received CRCT followed by radical surgery (group 1),and 122 received radical RT with concurrent chemotherapy (weekly cisplatin,40 mg/m2) (group 2).The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for survival difference analysis ; the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％ in groups 1 and 2.34 and 33 patients were followed up for at least 3 years in groups 1 and 2.The 3-year progression-free survival (PFS) rates,overall survival (OS) rates,and local control rates for groups 1 and 2 were 91.5％ vs 82.0％ (P =0.013),95.5％ vs 89.2％ (P =0.085),and 96.7％ vs 93.4％ (P =0.375),respectively.In group 1,the patients with a tumor diameter of ≥6 cm and an age of ≤35 years had a significantly lower 3-year PFS rate than those with a tumor diameter of ＜ 6 cm and an ageof＞35 years (68.2％ vs 93.8％,P=0.004;74.1％ vs 93.2％,P=0.037).In group 2,the patients with non-squamous cell carcinoma and a tumor diameter of ≥6 cm had a significantly lower 3-year PFS rate than those with squamous cell carcinoma and a tumor diameter of ＜ 6 cm (50.0％ vs 83.0％,P =0.013 ;25.0％ vs 86.0％,P =0.002).In groups 1 and 2,the patients with a tumor diameter of ≥6 cm had a significantly lower 3-year OS rate than those with a tumor diameter of ＜ 6 cm (78.8％ vs 97.0％,P =0.033 ;46.9％ vs 92.6％,P =0.007).Leg edema occurred more frequently in group 1 than in group 2 (33.1％ vs 8.2％,P=0.000),while radiation enteritis more frequently in group 2 than in group 1 (31.2％ vs 5.0％,P =0.000).Conclusions CRCT followed by radical surgery may lead to better PFS than radical RT with weekly cisplatin in patients with FIGO stage ⅡB cervical cancer.Tumor diameter is the common prognostic factor for PFS in patients who receive the two treatments.