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目的:探讨同步放化疗治疗Ib2期和IIa2期宫颈癌的疗效和不良反应,并分析预后影响因素。方法:回顾分析2000年1月至2010年12月首都医科大学附属北京妇产医院妇瘤科收治的73例接受同步放化疗的Ib2和IIa2期宫颈癌患者的临床病理资料。统计有效率和疾病控制率评价近期疗效,统计3年、5年无瘤生存率(DFS)及总生存率(OS)评价远期疗效,记录患者的不良反应,并分析可能影响患者预后的相关因素。结果:同步放化疗治疗Ib2期和IIa2期宫颈癌的有效率(CR+PR)为91.78%,疾病控制率(CR+PR+SD)为97.26%;3年DFS为84.93%,0S为86.30%;5年DFS为79.45%,0S为82.19%。所有不良反应患者均可耐受,对症治疗后均可缓解。单因素分析显示,患者的生存率与肿瘤的病理类型、分化程度、大小、有无淋巴结转移以及治疗前后血鳞状细胞癌抗原(SCC-Ag)值有关(P<0.05)。多因素分析表明,肿瘤病理类型、大小、有无淋巴结转移及治疗后1个月血SCC-Ag值为远期疗效的独立影响因素。结论:同步放化疗治疗Ib2期和IIa2期宫颈癌的近、远期疗效肯定,不良反应可耐受,是一种可供选择的方法。病理类型为腺癌、肿瘤直径﹥5cm、有淋巴结转移、治疗后1个月血SCC-Ag值≥1.5ng/ml者预后较差,需进一步加强研究。
Objective: To investigate the efficacy and adverse reactions of concurrent chemoradiotherapy in the treatment of stage Ib2 and stage IIa2 cervical cancer and to analyze the prognostic factors. Methods: The clinical and pathological data of 73 patients with stage Ib2 and stage IIa2 cervical cancer undergoing concurrent chemoradiotherapy admitted to the Department of Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2000 to December 2010 were retrospectively analyzed. Statistical efficiency and disease control rate evaluation of the recent curative effect, statistics 3 years, 5-year disease-free survival (DFS) and overall survival (OS) evaluation of long-term efficacy, record patient adverse reactions, and analysis may affect the prognosis of patients factor. Results: The response rate (CR + PR) of patients with stage Ib2 and stage IIa2 with concurrent chemoradiotherapy was 97.76%, the disease control rate was 97.26%, the 3-year DFS was 84.93%, and the OS was 86.30% ; 5-year DFS was 79.45%, 0S was 82.19%. All patients with adverse reactions can be tolerated, symptomatic treatment can be alleviated. Univariate analysis showed that the survival rate was related to the pathological type, degree of differentiation, size, lymph node metastasis and SCC-Ag before and after treatment (P <0.05). Multivariate analysis showed that the pathological type, size, presence or absence of lymph node metastasis and SCC-Ag in blood one month after treatment were independent influencing factors for long-term efficacy. Conclusions: The curative effect of concurrent chemoradiotherapy in the treatment of patients with stage Ib2 and stage IIa2 cervical cancer is definite and the side effects are tolerable. It is an alternative method. Pathological type of adenocarcinoma, tumor diameter> 5cm, lymph node metastasis, 1 month after treatment of blood SCC-Ag value ≥ 1.5ng / ml poor prognosis, the need to further strengthen the study.