| Objectives:To explore the best postoperative adjuvant therapy model for patients of ?a-?a cervical cancer by retrospectively reviewing the outcome of adjuvant therapies with different numbers of intermediate risk factors.Methods:All ?a-?a cervical cancer patients who experienced radical hysterectomy and were hospitalized in the radiotherapy department of the xxx hospital during January 1,2014 to December 31,2014 were collected.After excluding the patients with high risk factors,no adjuvant treatment and severe basic diseases,the case data of 99 clinical patients were finally included.According to the number of intermediate risk factors,the 99 patients were divided into four groups: intermediate risk factors =0,1,2 and3.According to the adjuvant treatment,the patients in each risk factors group were divided into three groups: radiotherapy alone,concurrent chemoradiotherapy and sequential chemotherapy.The above patients were followed up for 5 years,the 5 year-recurrence rate and mortality rate of different intermediate risk factors were calculated,and the rank sum test was used for the significance test.In every intermediate risk factor group,K-M survival analysis was used to calculate the 5-year PFS and OS of different adjuvant treatments,and the significance test was conducted by Log-Rank test.The incidence of grade 3/4 hematological toxicity and radiotherapy injury during adjuvant therapy was calculated.The Chi-square test or Fisher's exact test were used for the significance test.P<0.05 was considered statistically significant in overall comparison,and when each two group were compared P < 0.0167 was considered statistically significant according to Bonferroni correction.Results:1.In this study,a total of 99 ?a-?a patients followed surgy were included,with an average age of 49.45±8.84 years and an average follow-up time of 62.08 months(2-72 months).After 5 years of treatment,14 patients relapsed and 8 died,with a 5-year recurrence rate of 14.1% and a 5-year mortality rate of 8.1%.The 5-year progressionfree survival was 85.3% and 5-year overall survival was 91.6%.2.There was a significant relationship between the number of intermediate factors and the recurrence rate(P=0.020).There was no significant correlation between the number of intermediate factors and the mortality(P=0.137).3.In patients without intermediate risk factors,the 5-year PFS and 5-year OS were 92.9% and 100%,respectively.In this risk factor group the 5-year PFS and 5-year OS of the patients with radiotherapy alone,concurrent chemoradiotherapy and sequential chemotherapy were 87.5%,100% and 100%,respectively,and the 5-year OS were 100%,100% and 100%,respectively,with no significant difference in the overall comparison(P=0.687).The 5-year PFS of concurrent chemoradiotherapy and sequential chemotherapy was higher than that of radiotherapy alone,but there was no significant difference(P>0.0167).The incidence of lymphocyte grade 3/4 toxicity was the highest among the three adjuvant treatments(44.4%,100%,5%),with no significant difference(P=0.321).The grade 3/4 toxicity of lymphocytes in concurrent chemoradiotherapy and sequential chemoradiotherapy was higher than that in radiotherapy alone,but there was no significant difference between the two groups(P>0.0167).4.In the group with intermediate risk factors,5-year PFS and OS were 90.1% and 84.0%,respectively.The 5-year PFS of the patients with radiotherapy alone,concurrent radiotherapy and sequential chemotherapy were 70.8%,90.3% and 84.8%,and 5-year OS were 88.2%,93.5% and 87.9%,respectively,with no significant difference(P=0.189,P=0.733).The 5-year PFS and OS of concurrent chemoradiotherapy were higher than the other two groups,but there was no significant difference between the two groups(P>0.0167).There were significant differences in the incidence of grade 3/4 toxicity of leukocyte and lymphocyte in the three adjuvant treatments(0%,38.7%,18.2%,P=0.005,47.4%,80.6%,63.6%,P=0.050).The incidence of grade 3/4 toxicity of radiotherapy alone was significantly lower than that of concurrent chemoradiotherapy(P=0.000,P=0.001),and was no different from sequential chemotherapy.5.Intermediate risk factors=1 group,5-year PFS and OS were 90.1% and 84.0%,respectively.In this group,5-year PFS of patients with radiotherapy alone,concurrent chemoradiotherapy and sequential chemotherapy were 80.0%,93.8% and 100%,and 5-year OS were 90.0%,93.8% and 100%,respectively,with no significant difference(P=0.215,P=0.215).The 5-year PFS and OS of concurrent chemoradiotherapy and sequential chemotherapy were higher than that of radiotherapy alone,but there was no significant difference(P>0.0167).There were significant differences in the incidence of grade 3/4 toxicities among the three adjuvant treatments(0%,35.7%,41.7%,P=0.038).The grade 3/4 toxicity of lymphocytes in concurrent chemoradiotherapy and sequential chemoradiotherapy was higher than that in radiotherapy alone,but there was no significant difference between the two groups(P>0.0167).6.Intermediate risk factors=2 groups,5-year PFS and OS were 80.0% and 90.0%,respectively.In this group,5-year PFS of patients with radiotherapy alone,concurrent chemoradiotherapy and sequential chemotherapy were 60.0%,90.0% and 80.0%,respectively,and 5-year OS were 100%,100% and 80.0%,respectively,with no significant difference(P=0.362,P=0.200).The 5-year PFS and OS of concurrent chemoradiotherapy were higher than the other two groups,but there was no significant difference between the two groups(P>0.0167).There were significant differences in the incidence of grade 3/4 toxicity in the three adjuvant treatments(0%,35.7%,41.7%,P=0.038).The toxicity of grade 3/4 in the concurrent and sequential chemotherapy was higher than that in radiotherapy alone,but there was no significant difference(P>0.0167).7.Intermediate risk factors=3 groups,5-year PFS and OS were 69.2% and 84.6%,respectively.In this group,5-year PFS of patients with radiotherapy alone,concurrent chemoradiotherapy and sequential chemotherapy were 76.2%,91.2% and 86.2%,and 5-year OS was 100%,80.0% and 83.3%,respectively,with no significant difference(P=0.672,P=0.824).The 5-year PFS of concurrent chemoradiotherapy was higher than the other two groups,and the 5-year OS of radiotherapy alone was higher than the other two groups,but there was no significant difference between the two groups(P>0.0167).The incidence of lymphocyte grade 3/4 toxicity was the highest among the three adjuvant treatments(50.0%,80.0%,33.8%),with no significant difference(P=0.476).The grade 3/4 toxicity of lymphocytes in concurrent chemoradiotherapy and sequential chemoradiotherapy was higher than that in radiotherapy alone,but there was no significant difference between the two groups(P>0.0167).Conclusion:1.The number of intermediate risk factors had a significant effect on the 5-year recurrence rate of ?a-?a cervical cancer patients undergoing adjuvant therapy.2.In patients without intermediate risk factors,the effect of concurrent chemoradiotherapy and sequential chemoradiotherapy was not better than that of radiotherapy alone,and the incidence of grade 3/4 reaction was high.3.In patients with intermediate risk factors,postoperative concurrent chemoradiotherapy or sequential chemoradiotherapy was not superior to radiotherapy alone,and the incidence of grade 3/4 reaction was significantly increased.4.Adjuvant radiotherapy was not required in combination with concurrent chemotherapy or sequential chemotherapy for patients with ?a-?a cervical cancer,regardless of whether the number of intermediate risk factors was ?2. |
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