宫颈癌新辅助化学治疗的临床分析  

Clinical analysis of neoadjuvant chemotherapy in cervical cancer

作　　者：余敏华[1] 殷霞[1] 楼微华[1] 徐红[1] 祝捷[1] 施君[1] 狄文[1] YU Minhua;YIN Xia;LOU Weihuo;XU Hong;ZHU Jie;SHI Jun;DI Wen.(Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院妇产科,上海200127

出　　处：《上海医学》2018年第4期228-233,共6页Shanghai Medical Journal

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1302900);上海市卫生和计划生育委员会公共卫生三年行动计划重点学科建设计划--妇产科学(15GWZK0701);上海市重中之重临床医学中心和重点学科建设计划(2017ZZ02016)

摘　　要：目的探讨新辅助化学治疗(NACT)后宫颈癌患者的生存和复发情况,分析其预后的影响因素。方法收集上海交通大学医学院附属仁济医院在2014年1月—2016年12月间收治的术前行NACT的41例宫颈癌患者的临床病理资料。患者年龄29~76岁,平均年龄为(53.0±11.7)岁;宫颈癌国际妇产科联盟(FIGO)分期为ⅠB1期1例、ⅠB2期9例、ⅡA1期7例、ⅡA2期19例、ⅡB期5例;病理类型为鳞状细胞癌38例、腺癌2例、神经内分泌癌1例;其中妊娠期宫颈癌2例,均为鳞状细胞癌,FIGO分期为ⅠB1期和ⅠB2期各1例。行1次NACT 19例,行2次NACT 22例;NACT后所有患者均行手术治疗,其中39例完成广泛性全子宫切除+盆腔淋巴结清扫术,1例完成全子宫切除+盆腔淋巴结清扫术,1例仅完成盆腔淋巴结清扫术;术后病理分级G1 1例、G2 16例、G3 14例;20例浸润肌层深度>1/2,3例宫旁累及,10例淋巴结转移,1例神经束受侵,1例淋巴管血管间隙受累,6例脉管浸润。术后35例补充放射治疗,术后平均化学治疗次数(2.90±1.69)次。回顾性分析NACT后宫颈癌患者的生存和复发情况,探讨其预后因素。结果ⅠB2期、ⅡA1期、ⅡA2期、ⅡB期患者NACT后的肿瘤直径分别显著小于同组NACT前(P值分别为0.017、0.021、0.000、0.037)。41例宫颈癌患者在接受1或2次的NACT后,完全缓解5例,部分缓解25例,稳定7例,进展4例。30例患者对NACT有效,总有效率为73.17%(30/41),且行1次NACT与2次NACT后患者的临床缓解情况的差异无统计学意义(χ2=1.129,P=0.77)。随访时间为5~41个月,中位随访时间19.5个月。41例患者中,失访1例,肿瘤复发8例,死亡3例。在40例随访患者中,妊娠与否(P值分别为0.005、0.000)、是否行根治性子宫切除(P值分别为0.000、0.003)和术后病理提示是否宫旁累及(P值均为0.000)会影响患者的无进展生存时间(PFS)和总生存时间(OS)。基于术前行NACT的次数对患者分层后(行1和2次NACT的患者分别为Objective To investigate the prognostic factors through outcome and survival in cervical cancer patients treated with neoadjuvant chemotherapy （NACT）. Methods The clinicopathologic data of 41 patients with cervical cancer treated with NACT in our hospital was collected. The mean age of the 41 patients was （53.0±11.7） years （ranging from 29 to 76 years）. Clinical stage results were as follows, 1 case in International Federation of Gynecology and Obstetrics （FIGO） stage Ⅰ B1, 9 cases in stage Ⅰ B2, 7 cases in stage Ⅱ A1, 19 cases in stage Ⅱ A2 and 5 cases in stage Ⅱ B. There were 38 cases of squamous cell carcinoma, 2 cases of adenocarcinoma and 1 case of neuroendocrine carcinoma. Two patients were diagnosed with cervical squamous cell carcinoma during pregnancy, and one was in stage IB1 and the other in stage IB2. After one circle of NACT in 19 patients and two circles of NACT in 22 patients, surgical treatment was performed in all the patients, including 39 radical hysterectomy and pelvic lymph node dissection, 1 hysterectomy and pelvic lymph node dissection, and 1 pelvic lymph node dissection. Postoperative pathological conditions were G1 in 1 case, G2 in 16 cases and G3 in 14 cases; infiltrated muscle depths〉 1/2 in 20 cases, parametrial involvement in 3 cases, lymph node metastasis in 10 cases, nerve bundle invasion in 1 case, lymphatic vessel involvement in 1 case and vascular invasion in 6 cases. After surgery, 35 patients received supplemental radiotherapy, and the average number of chemotherapy was 2.90 ± 1.69. Results The maximum diameters of tumors were significantly reduced after NACT in patients in the stage Ⅰ B2, Ⅱ A1, Ⅱ A2 and Ⅱ B （P = 0. 017, 0. 021, 0. 000 and 0. 037）. After 1 or 2 circles of NACT, complete response was achieved in 5 patients, partial response in 25, stable condition in 7, and progression in 4. NACT was effective in 30 of 41 patients （73.17%）. There was no statistical difference in clinical remission between 1 and 2 circles of NACT （X

关 键 词：宫颈癌 新辅助化学治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]