Treatment Results and Prognostic Factors of FIGO Stage III and IVA Cervical Cancer Treated with Concurrent Chemoradiotherapy

FIGO第三期到第四期子宮頸癌患者接受同步化學放射治療後的結果與預後因子分析

楊皓涵(Haw-Harn Yang) ； 劉幕台(Mu-Tai Liu) ； 畢祖平(Chu-Ping Pi) ； 張東浩(Tung-Hao Chang) ； 黃昭源(Chao-Yuan Huang) ； 黃家俊(Chia-Chun Huang)

《放射治療與腫瘤學》 18卷4期 (2011/12) Pp. 275-286

https://doi.org/10.6316/TRO/201118(4)275

摘要

目的：統計局部晚期鱗狀細胞子宮頸癌患者，在本院接受同步化學放射治療後的結果與預後因子分析。材料與方法：自1999年1月到2008年12月總共106位被診斷為FIGO III－IVa期子宮頸癌病患，在本院接受過同步化學放射治療。其中有93位（87.7%）為鱗狀細胞癌患者做為本次回溯性分析的對象。存活率是以Kaplan-Meier method計算，單一變數分析是採用log－rank test，而多變數分析是採用Cox proportional hazards model。結果：病人年齡中位數為55歲（範圍介於34至86歲），追蹤時間中位數為57.05個月（範圍介於4.57－137.3個月）。5年的整體存活率為63.4%，5年的局部區域控制率和遠處轉移控制率分別為61.3% and 57.0%。34個病患（36.6%）發生局部復發或遠處轉移：9個病患產生局部復發，25個病患產生遠處轉移，其中有1病患同時有局部復發的現象。在單變數分析中，生活功能狀態（ECOG performance status）、腫瘤大小（大於4cm）、同步化學放射治療後鱗狀細胞癌抗原值仍升高（elevated serum SCC-Ag after CCRT）、治療前血紅素低下與盆淋巴轉移對於5年整體存活率、局部區域控制率和遠處轉移控制率是有意義的預後因子。在多變數分析中，生活功能狀態與同步化學放射治療後鱗狀細胞癌抗原值仍升高對於5年整體存活率和局部區域控制率是有意義的預後因子；生活功能狀態、同步化學放射治療後鱗狀細胞癌抗原值仍升高與腫瘤大於4公分對於5年遠處轉移控制率是有意義的預後因子。結論：在此研究中，病患的生活功能狀態較差、同步化學放射治療後鱗狀細胞癌抗原值仍升高與腫瘤大於4cm，其預後較差，對於這些病人可以考慮給予更積極的治療。[放射治療與腫瘤學2011；18(4)：275-286]

關鍵字

子宮頸癌 ； 同步化學放射治療 ； 預後因子

並列摘要

Purpose: To investigate the overall survival, local control and distant control of patients with locally advanced squamous cell carcinoma of the cervix treated with concurrent chemoradiotherapy (CCRT). We analyze the prognostic factors affecting their outcomes.Materials and Methods: We conducted a retrospective analysis of 106 patients with FIGO stage III-IVa carcinoma of the cervix treated with CCRT between January 1999 and December 2008 in our institution. Ninety-three patients with squamous cell carcinoma (87.7%). Survival estimations were analyzed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.Results: The median age at diagnosis was 55 years (range: 34-86 years). The median follow-up period was 57.05 months (range: 4.57-137.3 months) respectively. The 5-year overall survival (OS) rate was 63.4%, and 5-year local control (LC) and distant control (DC) rates of 61.3% and 57.0%, respectively. Thirty-four of 93 patients (36.6%) were diagnosed with recurrence or distant metastasis at the follow-up time. Twenty-five patients (26.8%) had distant failure, of which 24 had only distant metastasis, one patient had both distant and loco-regional recurrence, and the remaining 9 patients recurred locoregionally.ECOG performance status, tumor size, pelvic lymphadenopathy, pre-treatment hemoglobin and elevated serum SCC level after CCRT were significantly correlated with 5-year OS, LC and DC by univariate analysis. The ECOG performance status and elevated serum SCC after CCRT are significant prognostic factors for 5-year OS and LC rate. The performance status, tumor size (＞4 cm) and elevated serum SCC level after CCRT were significant for 5-year DC rate by multivariate analysis.Conclusions: The patient with poor ECOG performance status, bulky tumor (＞4cm) and elevated serum SCC after CCRT had worse outcome. More aggressive treatment may be considered for these patients.[Therapeut Radiol Oncol 2011; 18(4): 275-286]

並列關鍵字

Cervical carcinoma ； Concurrent chemoradiotherapy ； Prognostic factors