伴有淋巴结转移的ⅠB1～ⅡA2期宫颈癌两种治疗方式的回顾性研究  

A Retrospective Study of Early Stage(Ⅰ B1-Ⅱ A2) Cervical Cancer Patients with Lymphatic Metastasis Treated with Primary Chemoradiation Versus Radical Hysterectomy Followed by Ajuvant Chemoradiation

作　　者：张楠[1] 郑虹[1] 高雨农[1] 张乃怿[1] 宋楠[1] 高维娇[1] 高敏[1] 燕鑫[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《实用妇产科杂志》2017年第9期707-710,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:比较盆腔淋巴结切除术中病理检查证实有淋巴结转移的ⅠB1~ⅡA2期宫颈癌患者系统盆腔淋巴结切除术+同步放化疗与广泛子宫切除+系统盆腔淋巴结切除术+同步放化疗两种手术方式的疗效。方法:回顾性分析2007年10月至2016年3月在北京大学肿瘤医院治疗的盆腔淋巴结切除术中病理检查证实有淋巴结转移的ⅠB1~ⅡA2期宫颈癌患者44例的临床资料。19例患者在行系统淋巴结切除术后行同步放化疗治疗(放化疗组);25例患者在系统盆腔淋巴结切除术后继续行广泛子宫切除术,术后行辅助同步放化疗(根治手术组)。比较两种治疗方式患者的无进展生存情况和安全性。结果:44例患者中7例失访,中位随访时间为20月(4~90月)。放化疗组中,1例(1/15,6.7%)复发并死亡;根治手术组中,7例(7/22,31.8%)复发,3例(3/22,13.6%)死亡。放化疗组和根治手术组的无进展生存期中位数分别为49月(95%CI 29.216~68.784)、20月(95%CI17.682~22.318),差异无统计学意义(P=0.120)。放化疗组的2年无进展生存率为79.4%,根治手术组为36.2%,差异有统计学意义(P=0.020);1年无进展生存率差异无统计学意义(P=0.683)。发生Ⅲ~Ⅳ度不良反应放化疗组4例(26.7%),根治手术组7例(31.8%),两组差异无统计学意义(P=0.516)。结论:对于伴有淋巴结转移的ⅠB1~ⅡA2期宫颈癌患者,行系统淋巴结切除术后行同步放化疗的治疗方式与在系统盆腔淋巴结切除术后继续行广泛子宫切除术,术后行同步放化疗的治疗方式相比,安全性相当,而预后和生存结果似乎更好,但尚需大样本量的前瞻性研究证实。Objective：To compare two treatment modalities（chemoradiation versus radical hysterectomy plus chemoradiation） for early stage（ Ⅰ B1 - Ⅱ A2 ） cervical cancer patients with surgically confirmed lymphatic metas- tasis. Methods：Fourty-four Stage Ⅰ B1 - Ⅱ A2 cervical cancer cases with lymphatic metastasis confirmed by sys- temic pelvic and para-aortic lymph node dissection from 2007 to 2015 were reviewed. These patients were treated with either primary chemoradiation or radical hysterectomy followed by adjuvant chemoradiation after lymphadenectomy. The patient＇s outcome and treatment-related toxicities of two treatment modalities were compared. Results ：44 patients were eligible. Median follow-up time was 20（ range 4 -90） months and 7 patients lost follow-up. In primary chemoradi- ation group,1 patient（1/15,6. 7% ） relapsed and died,while in radical hysterectomy group,7 patiens（7/22,31.8%） relapsed and 3（3/22,13. 6% ） died. There was no significant difference in the mean progression-free survival between the two groups which was 49 （95% CI 29. 216 - 68. 784 ） months in primary chemoradiation group and 20 （ 95% CI 17. 682 -22. 318） months in radical surgery group（ P=0. 122）. There was significant difference in two-year pro- gression-free survival （ P = 0. 020 ） while no significant difference in one-year progression-free survival （ P =0. 683）. Grade 3 to grade 4 toxicity was comparable between the 2 groups（26.7% vs. 31.8%, P=0. 516）. Conclusions： For stage ⅠB1～Ⅱ A2 cervical cancer patients with positive lymph node,primary chemoradiation after pelvic and para-aortic lymphadenectomy seems to have better survival outcomes compared with radical hysterec- tomy plus chemoraditon in our retrospective study with limited cases. Evidence from a randomized controlled study is warranted to determine the optimal treatment for early stage cervical cancer with lymphatic metastasis.

关 键 词：ⅠB1~ⅡA2期宫颈癌 淋巴结转移 同步放化疗 广泛子宫切除 

分 类 号：R737.33[医药卫生—肿瘤]