摘要
目的分析术后辅助放疗对卵巢癌患者生存的影响。方法通过Surveillance,Epidemiology,and End Results(SEER)数据库检索并收集2011年至2015年间经病理确诊为卵巢癌并行原发病灶手术治疗的患者18529例,根据是否行术后辅助放疗分为无放疗组(n=18362)和辅助放疗组(n=167),应用Mann-Whitney U检验和χ^(2)检验比较组间各临床病理变量的差异,采用单因素和多因素Cox回归分析预测影响卵巢癌患者总生存(overall survival,OS)和肿瘤特异性生存(cancer special survival,CSS)的预后因素,采用Kaplan-Meier法进行生存分析。结果与无放疗组比较,辅助放疗组患者更年轻(中位年龄:56岁vs 59岁,P=0.036),病理多为非上皮性(χ^(2)=35.908,P<0.01),分化更差(χ^(2)=14.198,P=0.001),且淋巴结阳性(χ^(2)=13.424,P<0.01)、存在远处转移(χ^(2)=28.030,P<0.01)和接受化疗的比例更高(χ^(2)=21.496,P<0.01)。多因素分析显示,年龄、种族、病理类型、分化程度、肿瘤部位、分期、辅助放疗、化疗、肿瘤大小、糖类抗原125(carbohydrate antigen 125,CA125)水平以及R0切除情况均是影响卵巢癌患者OS和CSS的预后因素(均P<0.05),其中辅助放疗是卵巢癌患者预后的危险因素(HR=1.93,95%CI:1.56~2.38,P<0.01)。无放疗组和辅助放疗组中位OS分别为82个月和38个月,5年OS率分别为58.0%和31.9%。肿瘤分期、病理类型、分化程度以及R0切除情况亚组分析均提示,辅助放疗缩短卵巢癌患者的OS(均P<0.05)。结论辅助放疗不能改善卵巢癌患者的生存预后,且辅助放疗是影响预后的独立危险因素之一。
Objective To analyze the effect of adjuvant radiotherapy(RT)on the survival of patients with ovarian cancer.Methods A total of 18529 patients who were pathologically diagnosed with ovarian cancer from 2011 to 2015 and underwent primary site surgery were screened out from the Surveillance,Epidemiology,and End R esults(SEER)database and included in this study.Patients were divided into two groups according to with or without adjuvant RT(non-RT and adjuvant RT).Mann-Whitney U test andχ^(2) test were applied to compare the differences of clinicopathological variables between the two groups.Univariate and multivariate Cox regression analyses were utilized to predict the prognostic factors affecting overall survival(OS)and cancer special survival(CSS).Kaplan-Meier curve was used for survival analysis.Results Comparing to the non-RT group(n=18362),patients in the adjuvant RT group(n=167)were younger(median age:56 years vs 59 years,P=0.036),more non-epithelial on pathology(χ^(2)=35.908,P<0.01)and with worse differentiation(χ^(2)=14.198,P=0.001).Besides,the proportion of patients with positive lymph nodes(χ^(2)=13.424,P<0.01),distant metastasis(χ^(2)=28.030,P<0.01)and chemotherapy(χ^(2)=21.496,P<0.01)were higher in the adjuvant RT group.Multivariate regression analysis showed that age,race,pathological type,degree of differentiation,tumor site,stage,adjuvant RT,chemotherapy,tumor size,carbohydrate antigen 125(CA125)level and R0 resection were prognosis factors affecting the OS and CSS of patients with ovarian cancer(all P<0.05).Adjuvant RT was a risk factor for survival in ovarian cancer(HR=1.943,95%CI:1.586-2.379,P<0.01).The median OS of the non-RT and adjuvant RT groups were 82 months and 38 months,respectively,and the 5-year OS rates in the two groups were 58.0%and 31.9%,respectively.In the subgroup analyses of stage,pathological type,degree of differentiation and R0 resection,adjuvant RT shortened the OS of ovarian cancer patients(all P<0.05).Conclusions Adjuvant RT cannot improve the survival of ovarian cancer,
作者
虞鲁诗
龚虹云
李倩
宋启斌
Yu Lushi;Gong Hongyun;Li Qian;Song Qibin(Cancer Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《实用肿瘤杂志》
CAS
2021年第6期542-550,共9页
Journal of Practical Oncology
关键词
卵巢癌
辅助放疗
总生存
肿瘤特异性生存
预后
ovarian cancer
adjuvant radiotherapy
overall survival
cancer special survival
prognosis
