吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (05): 1002-1008.doi: 10.13481/j.1671-587x.20170527

• 临床研究 • 上一篇    下一篇

紫杉醇联合顺铂与单药顺铂2种同步放化疗方案对中晚期宫颈癌患者预后的影响及安全性评价

文思敏1, 于多2, 吕欣3, 王铁君2   

  1. 1. 吉林大学第一医院临床研究部, 吉林 长春 130021;
    2. 吉林大学第二医院放疗科, 吉林 长春 130041;
    3. 吉林大学公共卫生学院流行病与卫生统计学教研室, 吉林 长春 130021
  • 收稿日期:2017-03-06 出版日期:2017-09-28 发布日期:2017-09-29
  • 通讯作者: 王铁君,教授,博士研究生导师(Tel:0431-81875403,E-mail:544964566@qq.com) E-mail:544964566@qq.com
  • 作者简介:文思敏(1991-),女,吉林省长春市人,在读医学硕士,主要从事肿瘤分子流行病学方面的研究。
  • 基金资助:
    吉林省科技厅自然科学基金资助课题(20160101119JC)

Influence of docetaxel combined with cisplatinand single-agent cisplatin concurrent chemoradiotherapy in prognosis of patients with advanced cervical cancer and evaluation on security

WEN Simin1, YU Duo2, LYU Xin3, WANG Tiejun2   

  1. 1. Department of Clinical Research, First Hospital, Jilin University, Changchun 130021, China;
    2. Department of Radiotherapy, Second Hospital, Jilin University, Changchun 130041, China;
    3. Department of Epidemiology and Health Statistics, School of Public Health, Jilin University, Changchun 130021, China
  • Received:2017-03-06 Online:2017-09-28 Published:2017-09-29

摘要: 目的:探讨影响中晚期宫颈癌患者预后的相关因素,评价单药顺铂与紫杉醇联合顺铂(TP)2种方案对患者预后的影响及安全性,为中晚期宫颈癌的临床治疗提供依据。方法:选取在吉林大学第二医院放疗科行紫杉醇联合顺铂或单药顺铂2种同步放化疗方案的中晚期宫颈癌患者218例,根据其同步放化疗方案将所有患者分为单药顺铂组和紫杉醇联合顺铂组。所有患者均行体外照射联合高剂量率腔内近距离治疗。回顾性收集218例患者的年龄、肿瘤直径、临床分期、化疗方案、病理等级、病理类型和初产年龄等临床资料及治疗后的不良反应,并通过电话随访及门诊、住院复查资料的方式收集患者的生存资料,随访日期截止至2017年1月。比较2组患者临床病理资料的差异,分析所有患者临床病理资料与预后的关联性并评价2种同步放化疗方案的安全性。结果:2组患者年龄、肿瘤直径、临床分期、病理等级、病理类型和初产年龄比较差异无统计学意义(P > 0.05)。218例患者的1、3和5年生存率分别为96.33%、76.15%和63.76%,紫杉醇联合顺铂组患者5年生存率高于单药顺铂组(χ2=8.032,P=0.005)。单因素分析结果,与患者预后有关的因素是肿瘤直径、临床分期、化疗方案和病理类型为腺癌(P < 0.05)。多因素分析结果,患者的临床分期[Ⅲ期:P=0.016,HR(95% CI)=1.90(1.13~3.19);Ⅳ期:P<0.001,HR(95% CI)=19.13(7.84~46.68)],化疗方案[P=0.009,HR(95% CI)=0.54(0.34~0.86)]和病理类型为腺癌[P=0.021,HR(95% CI)=1.88(1.10~3.21)]是其预后的独立影响因素,且临床分期处于ⅡB期、采用紫杉醇联合顺铂同步放化疗方案和病理类型为鳞癌的患者预后较好。与紫杉醇联合顺铂组患者比较,单药顺铂组患者白细胞减少症(Z=-2.060,P=0.039)和嗜中性粒细胞减少症(Z=-2.246,P=0.025)不良反应较轻。结论:临床分期、化疗方案和腺癌病理类型是中晚期宫颈癌患者预后的独立影响因素。与采用单药顺铂比较,采用紫杉醇联合顺铂同步化疗方案患者预后较好,且不良反应仅略重于采用单药顺铂。

关键词: 紫杉醇, 顺铂, 宫颈肿瘤, 预后因素, 安全性

Abstract: Objective: To investigate the influencing factors of prognosis in the patients with advanced cervical cancer, and to evaluate the influence of single-agent cisplatin and docetaxel combined with cisplatin concurrent chemoradiotherapy in the prognosis of the patients and the security, and to provide the basis for clinical treatment of advanced cervical cancer. Methods: A total of 218 patients with advanced cervical cancer who received the single-agent cisplatin or docetaxel combined with cisplatin concurrent chemoradiotherapy were enrolled as the subjects. The patients were divided into two groups according to their chemoradiotherapy treatments:single-agent group and docetaxel combined with cisplatin concurrent group.All the patients had received external beam radiation therapy combined with high-dose rate intracavitary brachytherapy.A follow-up in 218 patients was performed until January 2017.The information about clinical characteristics including age, tumor diameter, clinical stage, chemotherapy treatments, pathological grade, pathological type, primiparous age and adverse effects after treatment were collected by telephone follow-up,outpatient service and reexamination.The differences in the clinical characteristics of the patients were compared between two groups,the association between the clinicopathological characteristics and the prognosis of the patients was analyzed, and the security of these two treatments was evaluated. Results: There were no statistical differences in the age, tumor diameter, clinical stage, pathological grade, pathological type and primiparous age of the patients between two groups(P>0.05).The 1-year, 3-year and 5-year overall survival (OS) rates of 218 patients were 96.33%, 76.15% and 63.76%, respectively.The 5-year OS rate of the patients in docetaxel combined with cisplatin group was higher than that of the patients in single-agent cisplatin group (χ2=8.032,P=0.005).The univariate analysis results indicated that tumor diameter, clinical stage, chemotherapy treatments, and adenocarcinoma were the potential predictive factors(P<0.05). The Cox regression analysis results showed that clinical stage[stage Ⅲ:P=0.016, HR(95%CI)=1.90(1.13-3.19)[stage Ⅳ:P<0.001, HR(95%CI)=19.13(7.84-46.68)], chemotherapy treatments[P=0.009, HR(95%CI)=0.54(0.34-0.86)] and adenocarcinoma pathological type[P=0.021, HR(95%CI)=1.88(1.10-3.21)]were the prognostic risk factors of the patients,the patients in clinical stage ⅡB,received docetaxel combined with cisplatin concurrent chemoradiotherapy and with pathological types of squamous cell carcinomas had a better outcome. Compared with docetaxel combined with cisplatin group, leucopenia (Z=-2.060,P=0.039) and neutropenia (Z=-2.246, P=0.025) in single-agent cisplatin group were lighter. Conclusion: Clinical stage,chemotherapy treatments and adenocarcinoma were the independently prognostic factors of the patients with advanced cervical cancer.The patients receive docetaxel combined with cisplatin concurrent chemoradiotherapy have a better prognosis and no severer adverse effects compared with single-agent cisplatin treatment.

Key words: docetaxel, cisplatin, cervical neoplasms, prognostic factors, security

中图分类号: 

  • R737.33