Clinical Aanlysis Of Postoperative Adjuvant Chemotherapy Combined With Radiotherapy For Early Stage Cervical Cancer With High Risk Of Recurrence

Background:Cervical cancer is one of the most common gynecologic malignancies.More than 85% of the patients are in developing countries,while the number of newly diagnosed cases in China accounts for about 1/4 of the total.Surgery is the preferred treatment for patients with early cervical cancer.The prognosis of most postoperative patients is good,but there are still many patients with tumor recurrence and distant metastasis.The NCCN Guidelines advocate the definition of high-risk recurrence of lymph node metastases,positive margins,uterine infiltration,large tumor volume,positive vascular thrombosis,and deep cervical interstitial infiltration.Some studies also suggest that the preoperative clinical stage is late,Lower degree of tumor tissue differentiation,histological type of non-squamous cell carcinoma and high risk of recurrence of the number of factors is also closely related with postoperative prognosis.For patients with early stage cervical cancer who have the above-mentioned high-risk relapse factors,the guidelines recommend adjuvant radiotherapy and chemotherapy,but whether combined adjuvant chemotherapy is not yet mentioned,and the domestic and foreign literature on this report varies.Therefore,for patients with early stage cervical cancer who have the above-mentioned high-risk recurrence factors,it is of great significance to explore the curative effect,toxic and side effects of adjuvant chemotherapy combined with radiotherapy as well as the clinicopathological features that affect the prognosis of early cervical cancer.Objective:To investigate the effect of adjuvant chemotherapy combined with radiotherapy on the survival and survival of patients with early-stage cervical cancerwho have high-risk recurrent factors after operation,and to analyze the correlation between adjuvant chemotherapy and regional lymph node metastasis,margins of paracancer,paracancerous infiltration,volume of primary tumor,tumor embolism,depth of cervical interstitial infiltration,Clinical stage,degree of tumor differentiation and histological types of high-risk recurrence factors such as prognosis,to provide guidance for clinical treatment and prognosis.Methods:Retrospective analysis of the complete clinical data of 88 patients with IB-IIA cervical cancer who had high-risk recurrence after undergoing adjuvant chemotherapy and radiotherapy in the Department of Oncology,Second Affiliated Hospital of Dalian Medical University from January 2010 to December2012,Follow-up at least 60 months after surgery.The postoperative patients were treated with adjuvant chemotherapy combined with radiotherapy for disease-free survival,overall survival and adverse reactions.At the same time,using single factor,Cox multivariate analysis of regional lymph node metastasis,positive margins,parametrial infiltration,primary tumor volume,the risk of cervical interstitial infiltration,the clinical stage,the degree of tumor tissue differentiation and the histological type were significantly correlated with the disease free survival(DFS)and overall survival(OS)of patients with early stage cervical cancer influences.According to the number of high risk relapse patients,the patients were divided into A(1-2),B(3-4)and C(?5).The 3-year and 5-year DFS and OS of the three groups were compared.Counting data were analyzed by SPSS 22.0 software,Kaplan-Meier method was used for univariate survival analysis,and Log-rank test was used for difference analysis.Multivariate analysis was performed by Cox risk regression model.Results:(1)The 3-year DFS and OS of 88 patients were 77.3% and 85.2%respectively.The incidence of distant metastases and local recurrence at 3 years was10.2% and 12.5%,respectively.The 5-year DFS and OS were 75.0% and 80.7%respectively.The incidence of 5-year distant metastases and local recurrences was11.4% and 13.6%,respectively.Postoperative adjuvant chemotherapy with radiotherapy(synchronous DDP sensitization)early toxicity mainly gastrointestinalreactions 30.7%(?~? degree)and 3.4%(? degree),bone marrow suppression44.3%(?~? degree)And 18.2%(? ~ ?degrees).The late side effects were mainly 13.6%(?~? degrees)of radiological proctitis.However,these patients can be tolerated side effects.(2)The results of univariate analysis showed that the clinical stage,lymph node metastasis,positive margins and the depth of interstitial infiltration were correlated with the 3-year and 5-year DFS(P <0.05).The lymph node metastasis,the positive margins and the depth of interstitial infiltration were associated with 5-year OS(P <0.05).Cox multivariate analysis showed that lymph node metastasis was positively correlated with 3-year and 5-year DFS(P <0.05);positive margins were associated with 3-year OS(P <0.05);lymph node metastases,positive margins,And histological type were all associated with 5-year OS(P <0.05).(3)According to the number of high-risk relapse factors,the three-year DFS were divided into A(1-2),B(3-4)and C(?5),83.3% and 38.9% respectively.The5-year DFS was 95.5%,79.2% and 38.9% respectively.The three-year OS was 95.5%,85.4% and 72.2% respectively.The 5-year OS was 95.5%,81.3% and 61.1% %.With the increase of the number of high-risk recurrent disease,the 3-year,5-year DFS and3-year and 5-year OS decreased gradually.The difference of 3-year and 5-year DFS and 5-year OS among the three groups was statistically significant).There was no significant difference in 3-year OS among the three groups(P> 0.05).Conclusion:(1)For patients with high-risk recurrence factors after early cervical cancer,the combination of concurrent chemotherapy and concurrent adjuvant chemotherapy with the current standard of concurrent radiotherapy and chemotherapy in the literature,patients have no obvious advantage in disease-free survival and overall survival.However,the incidence of distant metastasis was reduced,and the incidence of myelosuppression increased accordingly.Therefore,it is feasible to perform adjuvant chemotherapy for patients with early postoperative cervical cancer who have high-risk recurrence factors,but it is necessary to further expand the number of cases and conduct concurrent prospective controlled studies.(2)lymph node metastasis,parametrial invasion,positive margins andhistological types are independent risk factors for early postoperative cervical cancer patients.The higher the number of high-risk recurrent factors,the worse the prognosis of patients,the number of high-risk recurrent factors is an independent prognostic risk factors.For the factors such as primary tumor volume,tissue differentiation,and vascular tumor embolus,there is no significant effect on prognosis.A large-scale multicenter prospective controlled study and long-term follow-up data evaluation should be further explored.