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目的:探讨早期子宫内膜癌(EC)患者术后放疗的预后及其相关影响因素。方法:选取2012年9月到2016年9月在郑州大学附属南阳医院南阳市中心医院行全子宫双附件切除术的Ⅰ期EC患者250例,根据其手术-病理分期给予术后辅助性放射治疗。术后辅助放疗方式:单纯阴道内照射108例(43.2%),盆腔外照射43例(17.2%),内外联合照射99例(39.6%)。Kaplan-Meier法计算生存率并通过Logrank检验差异,Cox模型进行预后因素分析。结果:平均随诊时间(52.58±12.35)月,5年随访率为86.4%(216/250),总随访率为83.2%(208/250)。250例患者中,10例因EC复发恶化死亡,8例因原发或继发心脑血管疾病及其它高危疾病死亡。5年总生存期率和无进展生存期率分别为92.6%和89.5%。5年总复发转移率、远处转移率、局部复发率分别为8.4%(21/250)、6.4%(16/250)和4.8%(12/250)。单因素及多因素分析均显示,影响总生存期的主要影响因素为子宫下段受累(P=0.014)和放射治疗前贫血(P=0.009)。不良反应以轻中度为主,151例(60.4%)出现1、2级急性放射性肠炎,9例(3.6%)出现3级及以上不良反应,24例(9.6%)出现其他晚期不良反应。结论:Ⅰ期EC患者术后行辅助性放射治疗后的总体临床治疗效果良好,不良反应轻微。总生存期率的影响因素为放疗前贫血和子宫下段受累。
Objective: To investigate the prognosis and related factors of postoperative radiotherapy in patients with early endometrial cancer (EC). Methods: From September 2012 to September 2016, 250 patients with stage ⅠEC were treated with double-attachment hysterectomy in Nanyang Central Hospital Affiliated to Zhengzhou University. According to their surgical-pathological staging, postoperative adjuvant radiotherapy . Postoperative adjuvant radiotherapy: simple vaginal irradiation in 108 cases (43.2%), pelvic external irradiation in 43 cases (17.2%), internal and external combined irradiation in 99 cases (39.6%). The Kaplan-Meier method was used to calculate the survival rate and the difference was tested by Logrank. The Cox model was used to analyze the prognostic factors. Results: The average follow-up time was (52.58 ± 12.35) months. The 5-year follow-up rate was 86.4% (216/250). The overall follow-up rate was 83.2% (208/250). Of the 250 patients, 10 died of EC recurrence and 8 died of primary or secondary cardiovascular disease and other high-risk conditions. 5-year overall survival and progression-free survival rates were 92.6% and 89.5%. The 5-year total recurrence and metastasis rate, distant metastasis rate and local recurrence rate were 8.4% (21/250), 6.4% (16/250) and 4.8% (12/250) respectively. Univariate and multivariate analysis showed that the main influencing factors of overall survival were lower uterine involvement (P = 0.014) and anemia before radiotherapy (P = 0.009). Adverse reactions were mild to moderate. Grade 1 and 2 acute radiation enteritis occurred in 151 patients (60.4%). Grade 3 and above adverse reactions occurred in 9 patients (3.6%). Other adverse reactions occurred in 24 patients (9.6%). Conclusion: The overall clinical efficacy of adjuvant radiotherapy in patients with stage Ⅰ EC is good and the adverse reactions are mild. The factors affecting the overall survival rate were anemia before radiotherapy and involvement of the lower uterine segment.