Prognostic Analysis Of Postoperative Adjuvant Treatments Of Cervical Cancer With Lymphatic Metastasis In Stage ?A1-?A2

Objective: Operation is the main therapeutic method for cervical cancer in stage IA1-?A2.There are many postoperative risk factors,with which patients need to receive postoperative adjuvant therapies.In order to find the most appropriate adjuvant therapy with pathological lymphatic metastasis,this article studied clinical benefits and related adverse reactions of different postoperative treatments.Methods:225 stage ? A1-? A2 cervical cancer patients were selected from January 1,2008 to December 31,2014 in the Fourth Hospital of Hebei Medical University treated in the department of gynaecology with pathological lymphatic metastasis after radical surgery.Kaplan Meier method and Log-rank test were used for survival analysis and to compare prognosis of postoperative chemoradiotherapy(group A),radiation therapy(group B),chemotherapy(group C),and no additional adjuvant therapy(group D).The acute adverse reactions were compared by rank-sum test.Advantages and disadvantages of different adjuvant treatments were evaluated comprehensively in stage ? A1-? A2 cervical cancer with pathological lymphatic metastasis.SPSS 21.0 statistical software was used,and P < 0.05 was considered statistically significant.Results:1.The 3-year overall survival rates in group A,B,C and D were81.5%,60%,71.7% and 50.3% respectively.Univariate analysis showed that the overall survival time of group A was longer than that of group D(P=0.000),and group C was higher than that of group D(P=0.048).There was no statistically significant difference between the remaining groups.2.The 3-year disease-free survival rates in groups A,B,C and D were73.6%,60%,61.1% and 38.9% respectively.Univariate analysis showed thatthe disease-free survival time of group A was longer than that of group C(P=0.040)and group D(P=0.000),and group C was higher than that of group D(P=0.020).There was no statistically significant difference between the remaining groups.3.The 3-year locoregional recurrence-free survival rates in groups A,B,C and D were 81.6%,100%,71.1% and 53.7% respectively.Univariate analysis showed that the locoregional recurrence-free survival time of group A was longer than that of group C(P=0.043)and group D(P=0.000).There was no statistically significant difference between the remaining groups.4.The 3-year distant disease-free survival rates in groups A,B,C and D were 90.3%,60%,86% and 73.5% respectively.Univariate analysis showed that group A with distant disease-free survival was longer than that of group B(P =0.023)and group D(P = 0.005).There was no statistically significant difference between the remaining groups.5.The acute adverse reactions in each group were gastrointestinal disturbance,urinary disturbance,myelotoxicity and hepatic dysfunction.The gastrointestinal disturbance was found in group A,group B and group C,with total incidence of 28.7%,20% and 8.1% respectively,and group A was significantly more severe than group C(P=0.001).There were no statistically significant difference between the remaining groups.Urinary disturbance was found in group A and group B,with total incidence of 7.4% and 40%respectively,and group B was significantly more severe than group A(P=0.012).Myelotoxicity can be found in group A,group B and group C,with total incidence was 77.0%,60.0%,30.6% respectively,and group A was significantly more severe than group C(P = 0.000).There were no statistically significant difference between the remaining groups.Hepatic dysfunction was found in group A and group C,with total incidence of 27.0% and 24.2%respectively.There were no statistically significant difference between the groups(P=0.870).Conclusions:Postoperative chemoradiotherapy and chemotherapy could effectivelyreduce tumor recurrence and metastasis,and prolong the overall survival of patients.Postoperative chemoradiotherapy was more effective in prolonging the patients' disease-free survival than chemotherapy alone,especially in prolonging the locoregional recurrence-free survival.The acute toxicity of the chemoradiotherapy were more severe than those of the other groups,but they could be tolerated,and most of them could be cured by active therapeutic methods.