摘要
目的探讨术后单纯放疗和术后放化疗治疗软组织肉瘤(STS)的临床结局和不良反应方面的差异, 以及影响STS患者预后的因素。方法回顾性分析浙江省肿瘤医院2012年5月至2019年5月首诊确诊为原发性STS的患者, 术后接受辅助放疗, 伴或不伴术后化疗。共入组100例患者, 将其分为术后单纯放疗组(52例)与术后放化疗组(48例), 中位随访时间为65个月(24~124个月)。统计两组患者的无局部复发生存(LRFS)期、无远处转移生存(DMFS)期、总生存(OS)期和治疗相关不良反应。采用Kaplan-Meier法计算生存率, log-rank检验进行单因素分析, Cox模型行多因素分析。结果多因素分析显示, 肿瘤最长径是肿瘤局部复发的独立预测因素(HR=4.80, 95%CI=1.16~19.85, P=0.031), 同时也是远处转移(HR=4.67, 95%CI为1.53~14.26, P=0.007)和患者OS期(HR=4.10, 95%CI为1.35~12.48, P=0.013)的独立预测因素。另外, 接受放化疗患者的骨髓抑制程度显著高于单纯放疗患者(P<0.001)。结论在患者样本量有限的情况下, 与单纯放疗相比, 放化疗在远处转移或生存率方面没有改善, 不良反应增加, 但总体耐受性尚好。有必要进行大规模人群的前瞻性随机研究, 并对组织学亚型进行亚组分析, 以确保获得更有参考价值的结果。
Objective To analyze the differences in clinical outcomes and toxicities between postoperative radiotherapy alone and postoperative radiochemotherapy for soft tissue sarcoma(STS),as well as the related factors affecting clinical prognosis of STS patients.Methods Retrospective analysis of patients diagnosed with primary STS admitted to Zhejiang Cancer Hospital from May 2012 to May 2019 was performed,who received adjuvant radiotherapy after surgery,combined with or without postoperative chemotherapy.A total of 10o patients were enrolled and divided into postoperative radiotherapy group(n=52)and postoperative radiochemotherapy group(n=48).The median follow-up time was 65 months(24-124 months).The local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),overall survival(OS),and treatment-related toxicities were recorded in two groups.The survival rate was calculated by Kaplan-Meier analysis.Log-rank test was used for univariate analysis,and Cox model was used for multivariate analysis.Results In multivariate analysis,the maximum tumor diameter was an independent predictor of local tumor recurrence(HR=4.80,95%CI=1.16-19.85,P=0.031),distant metastasis(HR=4.67,95%CI=1.53-14.26,P=0.007)and 0S(HR=4.10,95%CI=1.35-12.48,P=0.013).In addition,the degree of myelosuppression in patients in postoperative radiochemotherapy was significantly higher than that in their counterparts in postoperative radiotherapy group(P<0.001).Conclusions In the limited number of patients,radiochemotherapy has no advantages over radiotherapy alone in distant metastasis or survival rate.Besides,it increases toxicities,but the overall tolerability is favorable.It is necessary to conduct prospective randomized studies in a large population and subgroup analysis of histological subtypes,aiming to obtain results with better reference value.
作者
李志磊
徐丽
沈金闻
周宁
张娜
刘鹏
卢珂
刘东
孙权权
冯燕茹
刘鲁迎
朱远
罗加林
Li Zhilei;Xu Li;Shen Jinwen;Zhou Ning;Zhang Na;Liu Peng;Lu Ke;Liu Dong;Sun Quanquan;Feng Yanru;Liu Luying;Zhu Yuan;Luo Jialin(Postgraduate Training Base Alliance of Wenzhou Medical University(Zhejiang Cancer Hospital),Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2023年第12期1057-1063,共7页
Chinese Journal of Radiation Oncology
关键词
软组织肿瘤
术后放射疗法
术后放化疗法
Soft tissue neoplasms
Postoperative radiotherapy
Postoperative chemoradiotherapy
