【作者】 陈艳；

【导师】 姜洁；

【作者基本信息】 山东大学 ， 妇产科学（专业学位）， 2016， 硕士

【摘要】 目的：比较高危Ⅰ期子宫内膜样腺癌术后放疗与化疗的疗效。方法：选取2000-2010年在安徽省立医院接受分期手术和术后辅助治疗的有高危因素的Ⅰ期子宫内膜样腺癌患者122例,依据术后治疗方法不同分成2组,放疗组72例,化疗组50例。比较两组的3年DFS和5年DFS,远处转移率以及局部复发率；并分析复发转移的危险因素。结果：(1)化疗组的3年DFS为80%(40/50),放疗组的3年DFS为94.9%(68/72),生存分析提示：放疗组优于化疗组(P<0.05)。(2)化疗组的5年DFS为76%(38/50),放疗组的5年DFS为91.7%(66/72),生存分析提示：放疗组优于化疗组(P<0.05)。(3)化疗组局部复发率：22%(11/50),放疗组的局部复发率为4.2%(3/72),统计学差异显著(P=0.002)；化疗组的远处转移率为2%(1/50),放疗组的远处转移率为4.2%(3/72),无统计学差异。(4)对复发转移的高危因素的分析提示：年龄大于60岁、肿瘤直径2cm以上、淋巴脉管浸润(LVSI)以及子宫下段或宫颈腺体受侵是复发的危险因素,术后接受放疗的患者复发率低于接受化疗的患者(P=0.016)。(5)放疗组近期毒性反应以胃肠道、泌尿道反应为主,多为1-2级,有5例发生3级放射性肠炎,1例发生3级骨髓抑制,化疗毒性反应主要系骨髓抑制,共6例(12%)发生3-4级骨髓抑制反应；远期的毒性反应主要发生在放疗组,包括阴道狭窄,慢性放射性膀胱炎及肠炎等,严重影响患者的生存质量。结论：(1)高危Ⅰ期子宫内膜样腺癌术后放疗的疗效优于化疗,放疗降低局部复发率,提高3年和5年DFS。但放疗的毒副反应较化疗严重,尤其是远期的毒性反应(阴道狭窄,慢性放射性肠炎、膀胱炎等),严重影响患者的生存质量。(2)年龄大于60岁、淋巴脉管间隙浸润、肿瘤直径2cm以上及子宫下段或宫颈腺体受侵均是影响Ⅰ期子宫内膜样腺癌患者预后的独立危险因素,术后化疗的患者复发率高于放疗的患者。更多还原

【Abstract】 Objective:To investigate the efficacy of postoperative adjuvant radiotherapy and chemotherapy in high-risk stage Ⅰ endometrial adenocarcinoma.Methods:2000-2010,122 cases of postoperative high-risk stage Ⅰ endometrial adenocarcinoma in Anhui Provincial Hospital had been enrolled in this study. According to different therapeutic methods,they were divided into 2 groups,72 cases in radiotherapy group and 50 cases in chemotherapy group.3-year DFS,5-year DFS, distant metastasis rate and local recurrence rate were compared, and the influence factors of recurrence and metastasis were analyzed.Results:(1) 3-year disease-free survival rate of radiotherapy group 94.9%(68/72) was statistically different from that of chemotherapy group 80%(40/50) (P<0.05).(2) 5-year DFS of radiotherapy group 91.7%(66/72) was statistically different from that of chemotherapy group 76%(38/50) (P<0.01).(3) Local recurrence rates of chemotherapy group and radiotherapy group were 22%(11/50) and 4.2%(3/72) respectively.The difference was statistically significant (P=0.002). Distant metastasis rates were 2%(1/50) and 4.2%(3/72) respectively.The difference was not statistically significant. (4) The analysis of the influence factors of recurrence and metastasis suggested that age (> 60 years old), tumor diameter (>2 cm),lymphatic vascular invasion (LVSI), and lower uterine segment or cervical glands infiltration are high risk factors. The recurrence rate of patients who received postoperative chemotherapy was higher than that in patients who received radiotherapy (P=0.016). (5) The gastrointestinal and urinary reactions are the mainly short-term toxicity of radiotherapy. Most of the toxicity were grade 1-2, however,5 cases developed grade 3 radiation enteritis, and 1 case developed grade 3 myelosuppression. In the chemotherapy group, the most common short-term toxicity is myelosuppression, a total of 6 cases (12%) developed grade 3-4 myelosuppression. The long-term toxicity mainly occurred in the radiotherapy group, including vaginal stenosis,chronic radiation cystitis and enteritis, and so on, which influence the life quality of the patients seriously.Conclusions:(1) The adjuvant postoperative radiotherapy is superior to chemotherapy in the high-risk stage I endometrial carcinoma. It can reduce local recurrence rate effectively, meanwhile, improve 3-year DFS and 5-year DFS. But the toxicity of radiotherapy is worse than chemotherapy, especially the long-term toxicity such as vaginal stenosis,chronic radiation enteritis and cystitis, and so on, which influence the life quality of the patients seriously.(2) Age (> 60 years old), LVSI, tumor diameter (>2 cm) and lower uterine segment or cervical glands infiltration are independent risk factors that influence the prognosis of high-risk stage I endometrial carcinoma patients,and the recurrence rate was higher in patients who received chemotherapy than in patients who received radiotherapy.更多还原