不同病理类型局部晚期(ⅠB2及ⅡA2期)宫颈癌的预后情况分析  

Prognosis of locally advanced cervical carcinoma(FIGO stage ⅠB2 and ⅡA2)with different pathological types

作　　者：朱安娜[1] 詹益州[2] 陈飞燕 李燕[1] 周莉[1] 李从铸[1] 关明飞[1] ZHU Anna;ZHAN Yizhou;CHEN Feiyan;LI Yan;ZHOU Li;LI Congzhu;GUAN Mingfei(Department of Gynecology,Cancer Hospital of Shantou University Medical College,Shantou 515000,Guangdong,China;Department of Radiotherapy,Cancer Hospital of Shantou University Medical College,Shantou 515000,Guangdong,China)

机构地区：[1]汕头大学医学院附属肿瘤医院妇科,广东汕头5150000 [2]汕头大学医学院附属肿瘤医院放疗科,广东汕头5150000

出　　处：《癌症进展》2020年第8期826-830,共5页Oncology Progress

摘　　要：目的探讨不同病理类型局部晚期(ⅠB2、ⅡA2期)宫颈癌的预后情况。方法选取169例ⅠB2、ⅡA2期宫颈癌(鳞状细胞癌149例,腺癌或腺鳞癌20例)患者,根据治疗模式的不同将其分为同期放化疗组、根治性手术组、新辅助化疗+根治性手术组。比较不同病理类型及不同治疗模式局部晚期宫颈癌患者的2年无复发生存率,分析120例接受过根治性手术的局部晚期宫颈癌患者的病理类型与其他临床特征的关系,并比较新辅助化疗+根治性手术组中不同病理类型局部晚期患者对新辅助化疗的反应。结果截至随访结束,随访超过2年者137例,2年无复发生存率为83.9%(115/137),其中,鳞状细胞癌患者的2年无复发生存率高于腺癌或腺鳞癌患者(P﹤0.05)。同期放化疗组、根治性手术组、新辅助化疗+根治性手术组患者的2年无复发生存率分别为77.3%、87.0%、87.2%。接受根治性手术或新辅助化疗后行根治性手术+术后辅助放疗和(或)化疗的120例宫颈癌患者中,肌层浸润情况与局部晚期宫颈癌患者的病理类型可能有关(P﹤0.05)。接受新辅助化疗+根治性手术+术后辅助放疗和(或)化疗的62例患者中,鳞状细胞癌患者58例,包括CR患者14例,PR患者40例,SD患者4例;腺癌/腺鳞癌患者4例,包括CR患者1例,PR患者3例。鳞状细胞癌患者与腺癌/腺鳞癌患者对新辅助化疗的反应比较,差异无统计学意义(P﹥0.05)。结论局部晚期宫颈癌患者的近期预后较好,腺癌或腺鳞癌患者的预后较鳞状细胞癌患者差。对于病理类型为腺癌/腺鳞癌的局部晚期宫颈癌,建议在治疗方式上较鳞状细胞癌更激进,不建议保留卵巢功能,更倾向于以根治性手术为主的综合治疗,可望改善患者预后。Objective To evaluate the prognosis of locally advanced cervical carcinoma(FIGO stage ⅠB2 and ⅡA2)with different pathological types.Method Totally,169 cases with locally advanced cervical carcinoma with FIGO stage ⅠB2 and ⅡA2(squamous cell carcinoma,n=149,adenocarcinoma or adenosquamous carcinoma,n=20) were enrolled in the analysis,and these patients were categorized as concurrent chemoradiotherapy group,radical hysterectomy group,neoadjuvant chemotherapy+radical hysterectomy group according to the therapies administered.The 2-year recurrencefree survival rate among patients of locally advanced cervical carcinoma with varying pathological types and therapeutic approaches were compared,besides,the pathological types and other clinical characteristics of 120 cases treated with radical hysterectomy were analyzed,and the response to neoadjuvant chemotherapy amid patients of locally advanced cervical carcinoma with differing pathological types receiving neoadjuvant chemotherapy+radical hysterectomy were also compared.Result As of the end of follow-up,a total of 137 cases were followed up for more than 2 years,showing a recurrence-free survival rate of 83.9%(115/13 7),besides,the 2-year recurrence-free survival rate among squamous cell carcinoma patients was higher than that in those with adenocarcinoma and adenosquamous carcinoma(P<0.05).The 2-year recurrence-free survival rates in concurrent chemoradiotherapy group,radical hysterectomy group and neoadjuvant chemotherapy+radical hysterectomy group were 77.3%,87.0%,and 87.2%,respectively.Among the 120 cases of cervical carcinoma underwent radical hysterectomy or neoadjuvant chemotherapy followed by radical hysterectomy+postoperative adjuvant chemotherapy and/or chemotherapy,pathological type was likely implicated with myometrial invasion(P<0.05).Additionally,in the 62 cases receiving neoadjuvant chemotherapy+radical hysterectomy+postoperative adjuvant chemotherapy,there were 58 cases of squamous cell carcinoma,including 14 cases achieving complete response(CR),

关 键 词：宫颈癌 化学疗法 新辅助化疗 局部晚期宫颈癌 鳞状细胞癌 腺癌 腺鳞癌 

分 类 号：R737.33[医药卫生—肿瘤]