摘要： 目的 评估术后“夹心模式”放化疗（化疗2~3个周期，放疗后再行2~3个周期化疗）治疗Ⅲ期子宫内膜癌的临床疗效及其影响因素。方法 回顾性分析我院收治的子宫内膜癌患者的临床资料，筛选出病理类型为子宫内膜样腺癌或子宫内膜腺鳞癌、临床分期为Ⅲ期、治疗方案为“夹心模式”放化疗的患者93例。比较完成治疗组与未完成治疗组间无复发生存期（DFS）的差异，分析与预后相关的临床因素以及导致治疗终止的原因。结果 93例患者中，64例（68.8%）完成既定治疗方案，DFS为1年、3年、5年的患者比例分别为98.44%、84.32%、80.75%； 29例（31.2%）未完成既定治疗方案，DFS为1年、3年、5年的患者比例分别为93.10%、72.1%、66.95%。与不良预后相关的临床因素包括病理分级为G₃ （HR=2.310，P=0.044）和化疗周期数<4 （HR=2.585，P=0.018）。导致治疗终止的首要原因为骨髓抑制（48.3%），其他原因包括患者主观因素（31.0%）、心律失常（5.9%）、肝损伤（5.9%）、肾损伤（2.9%）、脑梗死（2.9%）。结论 Ⅲ期子宫内膜癌患者术后完成“夹心模式”放化疗方案可获得较好的预后。改进治疗相关不良反应的预防和处理措施，加强患者的教育和管理，是顺利完成治疗的有效保障。

术后“夹心模式”放化疗治疗Ⅲ期子宫内膜癌的临床疗效

姜凤丽^1,2, 李扬², 康丹阳², 高嵩^1,2

1. 中国医科大学附属盛京医院 妇科肿瘤病房, 沈阳 110022;
2. 中国医科大学附属盛京医院 妇产科, 沈阳 110022

收稿日期:2023-05-09出版日期:2023-08-30发布日期:2023-08-07
通讯作者:高嵩E-mail:gaos@sj-hospital.org
作者简介:姜凤丽(1988-),女,医师,博士.
基金资助:沈阳市科学技术计划（21-173-9-61）


关键词: 子宫内膜癌, 放疗, 化疗
Abstract: Objective To evaluate the clinical efficacy and factors that influence "sandwich" adjuvant chemotherapy and radiotherapy (2-3 cycles of chemotherapy followed by 2-3 cycles of chemotherapy after radiotherapy) in the treatment of patients with stage Ⅲ endometrial cancer. Methods The clinical data of patients with endometrial cancer who were admitted to our hospital were retrospectively analyzed. A total of 93 patients with endometrioid adenocarcinoma or endometrial adenosquamous carcinoma at stage Ⅲ who underwent "sandwich" adjuvant chemotherapy and radiotherapy were included. Disease-free survival (DFS) was compared between the complete and incomplete treatent groups. Clinical factors related to prognosis and reasons of treatment termination were analyzed. Results Of the 93 patients,64 (68.8%) completed the established treatment regimen,the 1-,3-,and 5-year DFS rates were 98.44%,84.32%,and 80.75%,respectively. Meanwhile,29 (31.2%) did not complete the established treatment regimen,and they had 1-,3-,and 5-year DFS rates of 93.10%,72.1%,and 66.95%,respectively. The clinical factors associated with poor prognosis included pathologic grade G₃ (HR=2.310,P=0.044) and number of chemotherapy cycles <4 (HR=2.585,P=0.018). The most common reason for treatment termination was bone marrow depression (48.3%); other reasons included patient subjective factors (31.0%),arrhythmia (5.9%),liver injury (5.9%),kidney injury (2.9%),and cerebral infarction (2.9%). Conclusion Completion of the established "sandwich" chemoradiotherapy can allow patients with stage Ⅲ endometrial cancer to obtain a better prognosis. Improving the prevention and treatment of side effects and strengthening the education and management of these patients could help them complete the treatment regimen.
Key words: endometrial carcinoma, radiotherapy, chemotherapy
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