Retrospective Analysis Of Curative Effect And Prognostic Factors Of Radical Concurrent Chemoradiotherapy For Local Advanced Cervical Cancer

Objective: To explore the near and long-term efficacy,adverse reactions,and prognostic factors of Concurrent chemoradiotherapy(CCRT)in treatment of Locally advanced cervical cancer(LACC).In order to provide theoretical basis for prognosis prediction and accurate treatment of LACC patients.Method: The clinical data of 156 patients with locally advanced cervical cancer who received radical concurrent chemoradiotherapy in our hospital from January 2018 to December 2020 were retrospectively analyzed.The results included age,pathological type,clinical stage,tumor diameter,lymph node metastasis before treatment,hemoglobin in peripheral blood,Neutrophil to lymphocyte ratio(NLR),radiotherapy method and concurrent chemotherapy regimen.The short-term and long-term efficacy,survival and adverse reactions of patients were compared,and prognostic indicators of LACC patients receiving CRRT were sought.Results: After 3 months of treatment,the short-term efficacy was evaluated.Among156 patients with LACC,94(60.26%),42(26.92%),13(8.33%),and 7(4.49%)achieved complete response,partial response,stable disease,and disease progression,respectively.The objective response rate was 136(87.18%).The disease control rate was 149 cases(95.51%).The objective response rate was related to FIGO stage,tumor diameter and hemoglobin content before radiotherapy.In terms of long-term efficacy,the 1-year,2-year and 3-year overall survival rates of LACC patients were 98.1%,94.2% and 88.5%,respectively.The 1-year,2-year and 3-year progression-free survival rates were 87.8%,78.3% and 69.8%,respectively.For the analysis of prognostic factors,the optimal critical value of NLR was 3.08(sensitivity 0.852,specificity 0.682,area under curve 0.775,P < 0.001)according to the subject operating characteristic curve.Tumor pathological type(P=0.002),FIGO stage(P<0.001),tumor diameter(P=0.003),lymph node metastasis before treatment(P < 0.001),and NLR level before treatment(P< 0.001)were the factors affecting the overall survival rate of LACC patients.Patient age(P=0.003),tumor pathological type(P=0.022),FIGO stage(P<0.001),tumor diameter(P=0.007),lymph node metastasis before treatment(P< 0.001),hemoglobin level before radiotherapy(P=0.032),and NLR level(P< 0.001)were not advanced in LACC patients Factors influencing survival rate.Multivariate analysis showed that FIGO staging(stage II vs.IVA: HR=0.106,95%CI: 0.027-0.416,P=0.001;stage III vs.IVA: HR=0.161,95%CI: 0.048-0.538,P=0.003),tumor diameter(HR=3.285,95%CI: 1.100-9.807,P=0.033),lymph node metastasis before treatment(HR=2.699,95%CI 1.126-6.469,P=0.026)and NLR level before treatment(HR=4.030,95%CI1.443-11.251,P=0.008)were independent prognostic factors for overall survival in patients with LACC.FIGO staging(Stage II vs.IVA: HR=0.187,95%CI: 0.069 ～ 0.508,P=0.001;stage III vs.IVA: HR=0.288,95%CI: 0.109-0.759,P=0.012),lymph node metastasis before treatment(HR=2.960,95%CI: 1.585-5.529,P=0.001),NLR level before treatment(HR=3.189,95%CI: 1.610-6.314,P=0.001)was an independent prognostic factor for progression-free survival in LACC patients.The incidence of adverse reactions in LACC patients was as follows: 85 cases(54.49%)had myelosuppression,of which 16 cases(10.26%)had grade 3 and 13 cases(8.33%)had grade 4.There were 15 cases(9.62%)of acute lower digestive tract reaction,including2 cases(1.28%)of grade 3,no grade 4 reaction.There were 13 patients(8.33%)with chronic lower digestive tract reaction,including 3 patients(1.92%)with grade 3 and 2patients(1.28%)with grade 4.There were 12 cases(7.69%)with acute bladder reaction,among which 4 cases(2.56%)had grade 3 reaction without grade 4 reaction.There were4 cases(2.56%)with chronic bladder reaction,and no grade 3 or above reaction.Conclusion: The short-term and long-term efficacy of LACC patients receiving radical concurrent chemoradiotherapy is accurate,and the adverse reactions can be tolerated.FIGO stage,tumor diameter,NLR level before treatment and lymph node metastasis are independent prognostic factors for patients with locally advanced cervical cancer undergoing radical concurrent chemoradiotherapy.These risk factors should be strictly controlled,and accurate individualized treatment should be actively developed.It can improve the prognosis of patients.