新辅助化疗对ⅠB2～ⅡB期宫颈癌的临床疗效观察  

Clinical Outcomes of Neoadjuvant Chemotherapy on Patients with Stage ⅠB2-ⅡB Cervical Cancer

作　　者：叶磊[1] 朱建龙[1] 冯令达[1] 翁雷[1] 汪希鹏[1] 

机构地区：[1]同济大学附属第一妇婴保健院妇科,200040

出　　处：《国际妇产科学杂志》2014年第4期374-378,F0003,共6页Journal of International Obstetrics and Gynecology

摘　　要：目的：探讨新辅助化疗（NACT）对ⅠB2～ⅡB期宫颈癌术后病理常见高危因素以及对患者总体生存率的影响。方法：对2003年1月—2013年6月同济大学附属第一妇婴保健院收治的196例ⅠB2～ⅡB期宫颈癌患者进行回顾分析，将其中71例在术前接受了以铂类为基础的NACT的患者作为研究组；将125例进行直接手术（PST）的患者作为对照组。2组均广泛全子宫切除＋盆腔淋巴结清扫术或腹主动脉旁淋巴结切除术，年龄＞45岁者均行双附件切除术。观察NACT组化疗后局部肿瘤体积的变化，对NACT组与PST组术后病理中淋巴结转移、宫颈间质浸润深度、脉管内转移、巨块型、宫旁浸润及阴道切缘肿瘤浸润情况，以及对2组的生存率进行比较。结果：NACT组（统计缺失15例）化疗后肿瘤体积变化：完全缓解（CR）4例（7．1％），部分缓解（PR）27例（48．2％），持续存在（SD）18例（32．1％），肿瘤进展（PD）7例（12．5％）。术后病理分析中，NACT组较PST组，宫体大小及宫颈病灶宽度缩小、淋巴结切除数增多、巨块型宫颈癌中宫颈间质浸润＞1/2的发生率减少，差异有统计学意义（P＜0．05）。但除宫颈间质浸润＞1/2外的其他5个高危因素以及术中出血量、手术时间比较差异无统计学意义（P＞0．05）。 NACT组与PST组生存率比较差异无统计学意义（P＞0．05）。结论：NACT虽然有一定的近期临床疗效，但对于患者的总体生存率没有明显提高，因此在临床应用中需慎重考虑。NACT对控制巨块型宫颈癌术后病理高危因素有一定的效果。巨块型患者经过NACT后再手术是一种比较安全的方法。Objective：To discuss the impact of neoadjuvant chemotherapy （NACT） on high-risk factors as frequently reported by post-surgical pathology and the overall survival rate in patients with stage ⅠB2-ⅡB cervical cancer. Methods：A retrospective analysis was performed on the clinical data from 196 patients of stages ⅠB2-ⅡB cervical cancer admitted to First Maternity and Infant Hospital Affiliated to Tongji University during January 2003 to June 2013. Patients were divided into two groups： 71 cases received pre-surgical NACT based on platinum and taxol （NACT group） and 125 cases received primary surgical treatment （PST group） without pre-surgical NACT. Both groups received radical hysterectomy, bilateral salpingo-oophorectomy（age〉45 years old） plus pelvic lymph node dissection with or without para-aortic lymphadenectomy. In the NACT group, reduction in tumor size was observed after chemotherapy. Pelvic lymph node metastasis, depth of myometral invasion, lympho-vascular space invasion, bulky tumor, parametrial invasion, positive vaginal resection margin and survival rates were compared between the two groups. Results：In NACT group, data missing were 15 cases, 4 cases （7.1%） had complete remission （CR）, 27 cases （48.2%） had partial remission （PR）, 18 cases （32.1%） were stable disease （SD） and 7 cases （12.5%） were progression of disease （PD）. Compared with the PST group, patients in NACT group had greater reduction in the size of uterus and width of cervical lesion, more lymph nodes dissected, and fewer bulky tumors with≥50%thickness myometrial invasion （all P＆lt;0.05）. There were no statistically significant differences in other 5 high-risk factors and blood loss, duration of operation, the overall survival rate between the two groups （all P〉0.05）. Conclusions：Neoadjuvant chemotherapy has certain recent clinical curative effects, however, did not improve the overall survival rate, therefore, doctors should carefully consider the clinical appl

关 键 词：宫颈肿瘤 抗肿瘤联合化疗方案 淋巴转移 危险因素 预后 

分 类 号：R737.33[医药卫生—肿瘤]