| Objective To investigate therapeutic effect of concurrent chemoradiotherapy in patients with metaphase and advanced stage of squamous cell cervical carcinoma and analyze the relationship between the maximum tumor diameter(MTD)and the imaging lymph node status(LNs)as its prognosis.Methods 222 cases of metaphase and advanced stage of cervical squamous cell carcinoma patients were analyzed retrospectively from March 2007 to November 2008 in our Hospital.111 cases clinically diagnosed as IIb~IIIb stage used cisplatin and fluorouracil(PF)concurrent chemoradiotherapy as the experimental group.In the same period,the same conditions were treated with radiotherapy as control group.Curative effect,survival rate and complication were compared between two groups after treatment.To compare the survival distribution differences between patients with metaphase and advanced stage of squamous cell cervical carcinoma concurrent chemoradiotherapy were grouped by MTD and LNs.Results 1.Concurrent chemoradiotherapy group and radiotherapy group efficiency(CR + PR)in patients with metaphase and advanced stage of squamous cell cervical carcinoma were 97.3%(108/111),94.6%(105/111);IIb stage patients efficiency were 100%(48/48)and 97.9(47/48);III stage patients efficiency were 95.2%(60/63),92.1%(58/63).The differences were of no statistical significance(P > 0.05).2.In metaphase and advanced stage of squamous cell cervical carcinoma radiotherapy group compared with radiotherapy group,the 1-year survival rate was 94.6% v.s.86.5%,the difference were statistically significant(χ2=4.260,P=0.039<0.05);2-year survival rate was 85.6% v.s.70.3%,the difference were statistically significant(χ2=7.568,P < 0.01);3-year survival rate was 79.3% v.s.64.9%,the difference is statistically significant(χ2=5.729,P=0.017<0.05;4-year survival rate was 75.7% v.s.64.9%,5-year survival rate was 73.9% v.s.63.1%,the differences were of no statistical significance(P > 0.05).3.Rank Log showed that there were significant difference in survival distribution between concurrent chemoradiotherapy group of patients with metaphase and advanced stage of squamous cell cervical carcinoma by comparing to radiotherapy group(P<0.05).4.The recurrence rate,local failure rate,distant metastasis rate of concurrent chemoradiotherapy group were lower than radiotherapy group,the difference were not statistically significant(P>0.05).The incidence of the radiation proctitis and cystitis of concurrent chemoradiotherapy group were higher than radiotherapy group.The incidence of radiation proctitis were statistically significant(P <0.05).5.Concurrent chemoradiotherapyin patients with metaphaseand advanced stage of squamous cell cervical carcinoma were grouped by MTD(6cm)for critical value.The survival distribution difference between MTD ≥6 cm and MTD<6cm were statistically significant(P<0.05).The survival distribution difference between positive and negative group of the imaging lymph node status were statistically significant(P=0.00<0.01).6.Multivariate analysis confirmed that pelvic and/or para?aortic lymph node enlargement determined by imaging were significantly and independently related to poor outcomes.Univariate analysis confirmed that tumor diameter ≥6cm related to poor outcomes.7.When the patients areclassified into following three groups:(1)patients with MTD <6 cm and no pelvic lymph node enlargement;(2)patients with either MTD ≥6cm or lymphnode enlargement;(3)patients with both MTD≥6 cm and lymph node enlargement,the three groups significantly differ in survival distribution(log-rank test;P=0.001).Conclusion 1.Concurrent Chemoradiotherapy can improve 3-year survival rate of patients with metaphase and advanced stage of squamous cell cervical carcinoma.Especially the 2-year survival rate were significantly increased.However,the incidence of radiation proctitis were increased;2.Imaging lymph node enlargement were independent prognostic factor in patients with metaphase and advanced stage of squamous cell cervical carcinoma and Maximum tumor diameter ≥6 cm were risk factor in these patients;3.New treatment strategies should be considered for metaphase and advanced stage of squamous cell cervical carcinoma with maximum tumor diameter ≥6 cm and imaging lymph node enlargement. |
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