| Objective:To analyze the clinical curative effect,recurrence metastasis rate,and toxic and side effects of radiotherapy and concurrent chemoradiotherapy for 150 early-stage cervical cancer patients with intermediate-risk factors,and to evaluate the impact of different clinicopathological factors on the prognosis of cervical cancer.The purpose is to provide clinical data for the choice of adjuvant treatment options and prognosis risk factors for early-stage cervical cancer patients with intermediate-risk factors.Methods:From January 1,2009 to December 31,2012,we retrospectively analyzed the clinical data of 150 grade IB-IIA cervical cancer patients with intermediate risk factors included in the Cancer Center of Bethune First Hospital of Jilin University.According to postoperative adjuvant therapy,68 patients were divided into radiotherapy group and 82 patients with concurrent chemoradiotherapy group.The 5-year progression-free survival rate,5-year overall survival rate,recurrence and metastasis rate,and toxic and side effects of the two groups were compared.The effect of clinical factors on the prognosis was analyzed by univariate and multivariate analysis using a COX proportional hazards regression model.Results:The overall progression-free survival rate was 62.7% in the two groups,the progression-free survival rate was 47.1% in the radiotherapy group,and the progression-free survival rate in the concurrent radiochemotherapy group was 75.6%.The difference was statistically significant between the two groups(P<0.001).In the radiotherapy group,the five years average PFS was 43.7 months and 95% CI was 40.0-47.5.The five years average PFS was 51.0 months in the concurrent chemoradiotherapy group,and the 95% CI was 48.5-54.8.There was a statistically significant difference in the PFS between the two groups(P=0.002).The total 5-year survival rate was 74.7% in the two groups,the 5-ye ar survival rate was 63.2% in the radiotherapy group,and the 5-year survival rate in the concurrent radiochemotherapy group was 84.1%.There was a statistically significant difference between the two groups(P=0.003).The five years average OS of radiotherapy group was 51.6 months and 95% CI was 48.3-53.7.The five years average OS of concurrent radiochemotherapy group was 56.8 months,and the 95% CI was 54.8-58.9.There was a statistically significant difference between the two groups in OS(P=0.003).The local recurrence rate was 25.0% in the radiotherapy group and 11.0% in the concurrent radiochemother apy group.There was a statistically significant difference between the two gro ups(P=0.024).The distant metastasis rate was 27.9% in the radiotherapy group and 13.4% in the concurrent radiochemotherapy group.There was a statistica lly significant difference between the two groups(P=0.027).The main toxicities and side effects of the radiotherapy group and the concurrent radiochemotherapy group were myelosuppression and gastrointestinal reactions.There were significant differences between the two groups in myelosuppression and gastrointe stinal reactions(P=0.016,P=0.034).The long-term toxicity of radiotherapy group and concurrent radiochemotherapy group was radiation proctitis and radiation cystitis.There was no significant difference between the two groups in radiation proctitis and radiation cystitis(P=0.943,P=0.879).The 5-year survival rat e(P=1.000),5-year progression-free survival rate(P=0.307),local recurrence rate(P=0.505),and distant metastasis rate of cisplatin monotherapy group and cisplatin combined paclitaxel group in concurrent radiochemotherapy(P=0.500),the difference was not statistically significant.There were significant differences in myelosuppression and gastrointestinal reactions between cisplatin monotherapy group and cisplatin combined paclitaxel group(P=0.040,P=0.033).There was no significant difference between radioactive proctitis and radiation cystitis(P=0.755,P=0.681).Univariate analysis of prognosis in 150 early-stage cervic al cancer patients showed that tumor size was associated with PFS(P=0.043).The degree of differentiation,lymphatic vessel invasion,and the number of risk factors were related to PFS(P<0.05)and OS(P<0.05).Multivariate analysis showed that the number of risk factors and lymphatic vessel space invasion were independent risk factors for PFS(P=0.016,P<0.001)and OS(P=0.002,P<0.001)in patients with early cervical cancer.Conclusion:1.Concurrent chemoradiotherapy can improve the progression-free survival rate and overall survival rate,and reduce the local recurrence rate and distant metastasis rate.2.The toxic and side effects of concurrent chemoradiotherapy are more serious,mainly reflected in myelosuppression and gastrointestinal reactions,mainly grade I~II reaction,but can be tolerated.3.The efficacy of cisplatin monotherapy and cisplatin combined with paclitaxel in the concurrent chemoradiation group was comparable.4.The degree of differentiation,tumor size,lymph vascular space invasion and the number of risk factors were the prognostic factors in the early-stage cervical cancer patients.The lymph vascular space invasion and the number of risk factors were independent risk factors.5.Concurrent chemoradiotherapy can be used as an optimal treatment for early cervical cancer with intermediate risk factors. |
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