中国大陆部分地区局部晚期宫颈癌术前静脉化疗和术前动脉化疗对比研究  

Comparative study on preoperative arterial chemotherapy and venous chemotherapy for locally advanced cervical cancer in some parts of China's Mainland

作　　者：姜文轩 王璐[1] 刘萍[1] 李维丽[1] 郭建新 王绍光[3] 赵卫东[4] 倪妍 康山 杨鹰 郝敏[8] 陈春林[1] 郎景和[9] JIANG Wen-xuan;WANG Lu;LIU Ping;LI Wei-li;GUO Jian-xin;WANG Shao-guang;ZHAO Wei-dong;NI Yan;KANG Shan;YANG Ying;HAO Min;CHEN Chun-lin;LANG Jing–he(Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515 [2]陆军军医大学大坪医院妇产科,重庆400042 [3]烟台毓璜顶医院妇产科,山东烟台264000 [4]安徽省肿瘤医院妇产科,安徽合肥230009 [5]运城市中心医院妇产科,山西运城044000 [6]河北医科大学第四医院妇产科,河北石家庄050011 [7]陆军军医大学新桥医院妇产科,重庆400037 [8]山西医科大学第二医院妇产科,山西太原030001 [9]中国医学科学院北京协和医院妇产科,北京100730

出　　处：《中国实用妇科与产科杂志》2018年第11期1253-1257,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：十二五国家科技支撑计划(2014BAI05B03);国家自然科学基金(81272585;81370736;81571422);广州市科技计划(158100075);南方医科大学高水平建设临床研究重点项目(LC2016ZD019)

摘　　要：目的探讨局部晚期宫颈癌术前静脉化疗和术前动脉化疗两种途径化疗方案、疗程及近期疗效的差异。方法回顾性分析2004—2016年中国大陆地区34家医院30 665例宫颈癌病例,选择术前行静脉化疗或动脉化疗的患者1000例,其中静脉组893例,动脉组107例,以妇科检查结合影像学检查评价新辅助化疗前后病灶大小变化,分析两组在化疗方案、疗程及近期疗效的差异。结果 (1)两组化疗方案可归纳为紫杉醇类+顺铂组、紫杉醇类+非顺铂铂类组、非紫杉醇类+顺铂类组、非紫杉醇类+非顺铂铂类组、铂类单药组、非铂类药物组6组。(2)两组化疗方案差异:静脉组6种方案占比分别为44.12%、31.69%、19.04%、4.82%、0、0.34%;动脉组分别为6.54%、1.87%、66.36%、16.82%、7.48%、0.93%,差异有统计学意义(P<0.05)。(3)两组化疗疗程差异:静脉组1、2、≥3疗程占比分别为37.96%、55.99%、6.05%,平均为(1.68±0.58)疗程;动脉组分别为90.65%、9.35%、0,平均为(1.09±0.29)疗程,差异有统计学意义(P<0.05)。(4)两组化疗疗程与近期疗效差异:(1)分别以化疗1疗程及2疗程为截点,静脉组和动脉组近期总体有效率相近(52.07%vs. 50.47%,79.42%vs. 80.00%),差异无显著性意义(P>0.05);(2)以最后一次化疗结束为截点,静脉组有628例(70.32%)达到有效标准,化疗1、2、≥3疗程分别为183例(29.14%)、404例(64.33%)和41例(6.53%),平均疗程为(1.77±0.55)个;动脉组有57例(53.27%)达到有效标准,化疗1、2、≥3疗程分别为49例(85.96%)、8例(14.04%)和0例(0),平均疗程为(1.14±0.35)个,整个化疗过程中动脉组平均化疗疗程少于静脉组(P<0.05)。结论 (1)ⅠB2期及ⅡA2期局部晚期宫颈癌,术前静脉化疗常使用紫杉醇类+顺铂类方案,以2疗程为主;术前动脉化疗常使用非紫杉醇类+顺铂类方案,以1疗程为主。(2)当使用2疗程以内时,两组化疗有效率相近;当最后一次化疗结束后达到同一疗效时,术前动脉Objective To compare the difference in the chemotherapy regimen,treatment course and short-term clinical effect between preoperative intravenous chemotherapy and preoperative arterial chemotherapy for locally advanced cervical cancer.Methods A retrospective analysis of 30 665 cervical cancer cases in34 hospitals in China's Mainland from 2004 to 2016 was carried out.According to the selection criteria,1000 patients were selected for intravenous chemotherapy or arterial chemotherapy before surgery,of which 893 were in intravenous group and 107 in arterial group.Gynecological and imaging examination were used to evaluate the changes of lesion size before and after neoadjuvant chemotherapy.The differences between the two groups in chemotherapy regimen,treatment course and short-term clinical effect were analyzed.Results（1）The chemotherapy regimens of the two groups can be summarized into six groups： paclitaxel plus cisplatin group,paclitaxel plus non-cisplatin platinum group,non-paclitaxel plus cisplatin group,non-paclitaxel plus non-cisplatin platinum group,platinum monotherapy group and non-platinum drug group.（2）The difference between the two groups in chemotherapy regimens：the proportion of the six groups of regimen in the intravenous chemotherapy patients was 44.12%,31.69%,19.04%,4.82%,0 and 0.34% respectively,while in arterial patients it was 6.54%,1.87%,66.36%,16.82%,7.48%,0.93% respectively.The difference was statistically significant（P〈0.05）.（3）The difference between the two groups in the course of chemotherapy： the proportion of 1,2 and ≥3 courses of treatment in intravenous group was 37.96%,55.99%and 6.05% respectively,with the average course of treatment being（1.68±0.58）.In the arterial group it was 90.65%,9.35% and 0 respectively,and the average course of treatment was（1.09 ± 0.29）,the difference being statistically significant（P〈0.05）.（4）Difference in treatment course and short-term clinical effect between the two groups：（1） With1 course and 2 courses

关 键 词：宫颈肿瘤 术前静脉化疗 术前动脉化疗 对比研究 

分 类 号：R737.33[医药卫生—肿瘤]