Outcome And Prognostic Factors Of136Advanced Cervical Cancer Patients Treated With Concurrent Chemoradiotherapy

Objective:A retrospective review of136patients with advanced stage cervical cancer treatedwtih chemoradiotherapy was conducted with the aim of assessing the five-year survivalrate and identifying prognostic factors，in the hope of finding changeable factors toincrease survival rates of patients with advanced stage cervical cancer.Material and Methods:The medical records of136patients with International Federation of Gynecologyand Obstetrics stage IIb and IIIb who were treated at The Tumor Hospital of LiaoNingProvince between March2007and September2008were reviewed and analyzed.Thesepatients all completed the radiation treatment(external beam radiotherapy andintracavitary radiation)and chemotherapy(cis-platinum and5-fluorouracil),TheKaplan-Meier method was used to determine overall survival,log-rank tests was used tocompare survival and Cox reggression analysis was used to identify potential prognosticfactors.Results:The median follow-up period was61.9months(range,4.6-79.6) and46cases ofdeath had occurred, all the cause of death are tumor recurrence and metastasis. The5-year overall survival rates was66.2%; On univariate analysis,the overall survival ofyoung、middle-aged and old group were50%,73%and37.5%，P=0.012，the differencehad statistically sense; the overall survival of stage IIb and stage IIIb were82.9%and 60.4%，P=0.014，the difference had statistically sense; the overall survival of squamouscarcinoma and adenocarcinoma were68.5%and16.7%，P=0.00，the difference hadstatistically sense; the overall survival of high differentiated,moderately differentiatedand poorly differentiated were67.7%,71%and25%，P=0.001，the difference hadstatistically sense，but the difference of the overall survival of high differentiated andmoderately differentiated had not statistically sense(P=0.637); the overall survival oftumor size<4cm,tumor size of4-6cm and tumor size>6cm were75%,65.2%and40%，P=0.017，the difference had statistically sense; the overall survival of pretreatment Hblevel<110g/L and pretreatment Hb level>110g/L were41.7%和71.5%，P=0.012，thedifference had statistically sense; the overall survival of overall treatment time≤9weeks and treatment time>9weeks were76.1%and56.5%，P=0.018,the difference hadstatistically sense; all these clinicopathologic characteristics have a significant impacton survival time of patients. tumor gross type was distributed into five kinds:cauliflower type,ulcerative type,cervical canal type,tuberculous type and mixtedtype,the overall survival were69.8%,68.6%,100%,53.6%and50%，P=0.285,the effecton the overall survival of patients had not statistically sense. Multivariate analysis ofCox model show that stage(P=0.01),degrees of pathological(P=0.001),pretreatment Hblevel(P=0.004) and treatment time(P=0.026) had a significant effect on overall survival,these are independent prognostic factors for survival. The influence on the five-yearsurvival for patients of tumor size9(P=0.313),pathologic type(P=0.155),age(P=0.775)and tumor gross type(P=0.176) was not statistically significant.Conclusions:The results of statistic analysis show that the5-year overall survival is comparablewith reports of home and abroad. In clinical treatment of patients with advancedcervical cancer, some clinicopathologic characteristics are immutable factors, as stageand degree of pathological etc, but we can improve outcomes for patients throughchange any other variable factors,for example improving pretreatment Hb level andfollowing radiotherapy plan strictly.