作　　者： (李慧灵）;

机构地区： 福建省肿瘤医院福建医科大学附属肿瘤医院妇瘤科,福州350014

出　　处： 《中华放射肿瘤学杂志》 2017年第9期1028-1032,共5页

摘　　要： 目的 回顾分析宫颈癌术后阴道断端复发放疗的远期疗效及不良反应,以期探讨影响预后的因素。方法 收集2005—2011年间本院收治的105例宫颈癌术后阴道断端复发患者,按照复发时间分为3个组：A组6~12个月复发,B组12~24个月复发,C组≥24个月复发。所有患者复发后均行放疗,其中96例联合化疗。比较组间远期疗效、不良反应及影响预后因素。采用Kaplan-Meier法进行生存曲线分析。结果 全组患者3、5年生存率分别为58.1%、31.4%,中位生存时间为42个月。3个组中位生存时间比较C组优于A组（P=0.010）。肿瘤最大径〈4 cm的患者治疗效果优于≥4 cm者（P=0.000）。复发病灶局限于阴道断端治疗中位生存时间为47个月,超出阴道断端为32个月（P=0.005）。结论 放疗可以作为宫颈癌术后阴道断端复发的挽救性治疗方案,临床疗效显著。复发时间、肿瘤大小及肿瘤侵犯范围是影响宫颈癌术后阴道断端复发的重要因素。 Objective To analyze the long-term efficacy and adverse effects of radiotherapy in the treatment of recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, and to investigate prognostic factors. Methods A total of 105 patients who were admitted to our hospital due to recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer from January 2005 to July 2011 were enrolled in this study and divided into group A （6-12 months）, group B （12-24 months）, and group C （≥24 months） according to the time to recurrence. All patients received radiotherapy and only 96 patients also received concurrent chemotherapy. The long-term outcomes and adverse events were compared between the three groups, and the prognostic factors were analyzed. Survival curves were analyzed by the Kaplan-Meier method. Results The follow-up rate was 98.1%. The response rates of group A, B, and C were 60%, 82%, and 86%, respectively. The 3-and 5-year survival rates for all patients were 58.1% and 31.4%, respectively. The median survival time for all patients was 42 months. Group C had a significantly longer median survival time than group A （P=0.010）. The patients with a maximum tumor diameter of〈4 cm had a significantly better treatment outcome than those with a maximum tumor diameter of ≥4 cm （P=0.000）. There was a significant difference in median survival time between the patients with recurrent lesions limited to the vaginal cuff and those with recurrent lesions beyond the vaginal cuff （47 months vs. 32 months, P=0.005）. Conclusions For patients with recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, radiotherapy is a salvage treatment and has significant clinical efficacy. The treatment outcome and prognosis are related to time to recurrence, tumor size, and the extent of recurrent lesions.

关 键 词： 肿瘤复发 阴道断端 放射疗法 肿瘤复发 阴道断端 化学疗法 预后