基于倾向评分匹配分析调强放疗在宫颈癌中的应用研究

doi:10.3760/cma.j.cn113030-20220913-00304

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摘要目的比较调强放疗（IMRT）和三维适形放疗（3D-CRT）在宫颈癌根治性放疗中的疗效和不良反应。方法回顾性分析浙江省肿瘤医院2013年9月至2016年12月收治的1002例根治性放疗的宫颈癌患者资料,根据不同的体外放疗方式,分为IMRT组和3D-CRT组,通过1∶1倾向评分匹配后,分析两组的临床结局差异。连续变量用$\bar{x} \pm s$或M表示,分类变量用例数（百分比）表示。定量资料比较采用t检验,定性资料比较采用χ²检验或Fisher精确检验。采用Kaplan-Meier法和log-rank检验计算不同组别的生存率。结果 IMRT组比3D-CRT组有更多的患者接受了腹主动脉旁延伸野放疗（14.9%∶1.2%,P<0.001）,IMRT组淋巴结放疗剂量≥55 Gy的患者比例显著高于3D-CRT组（26.6%∶15.5%,P=0.002）。IMRT组的5年无瘤生存（DFS）率（74.6%∶68.9%,P=0.084）和总生存（OS）率（79.4%∶74.9%,P=0.270）均略高于3D-CRT组,但差异无统计学意义。IMRT组局部复发率和远处淋巴结转移率显著低于3D-CRT组,分别为3.0%∶6.9%（P=0.020）和4.2%∶9.0%（P=0.013）。IMRT组比3D-CRT组发生3-4级白细胞减少（46.3%∶37.9%,P=0.028）和贫血（18.8%∶14.0%,P<0.001）等不良反应的情况更严重。结论 IMRT和3D-CRT两种放疗方式在宫颈癌根治性放疗中均取得良好的治疗效果,而IMRT可以对转移淋巴结实现更高的放疗剂量,在降低宫颈癌局部复发和远处淋巴结转移方面有显著的优势。

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	饶慧婷
	冯涛
	毋楚樊
	楼寒梅
	吕晓娟

关键词 ：宫颈肿瘤, 放射疗法,根治性, 预后, 复发, 倾向评分匹配

Abstract：Objective To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer. Methods Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median. Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.

Key words： Uterine cervical neoplasms Radiotherapy,radical Prognosis Recurrence Propensity score matching

收稿日期: 2022-09-13

基金资助:浙江省医药卫生科技计划项目（2018KY306、2022KY647）; 浙江省医药卫生重大科技计划重点项目（WKJ-ZJ-2020）

通讯作者: 吕晓娟,Email：lvxj@zjcc.org.cn

引用本文:

饶慧婷,冯涛,毋楚樊等. 基于倾向评分匹配分析调强放疗在宫颈癌中的应用研究[J]. 中华放射肿瘤学杂志, 2023, 32(5): 415-421.

Rao Huiting,Feng Tao,Wu Chufan et al. The efficacy of intensity-modulated radiotherapy in radical radiotherapy for cervical cancer: a propensity score matching analysis[J]. Chinese Journal of Radiation Oncology, 2023, 32(5): 415-421.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20220913-00304 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2023/V32/I5/415

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