2018年FIGO子宫颈癌新分期中ⅡA2期治疗策略的探讨  

Treatment strategy for stageⅡA2 cervical cancer in FIGO new stage 2018

作　　者：孙立新[1] 付佳鑫 王莉[3] 赵宏伟[1] 王丹波 林丽红[5] 吕秋波[6] 郝敏[7] 卢逸嘉 宾晓农 郎景和 刘萍[2] 陈春林[2] SUN Li-xin;FU Jia-xin;WANG Li;ZHAO Hong-wei;WANG Dan-bo;LIN Li-hong;LYU Qiu-bo;HAO Min;LU Yi-jia;BIN Xiao-nong;LANG Jing-he;LIU Ping;CHEN Chun-lin(不详;Department of Gynecology,Shanxi Cancer Hospital,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院妇科,山西太原030013 [2]南方医科大学南方医院妇产科,广东广州510515 [3]河南省肿瘤医院妇科,河南郑州450008 [4]中国医科大学肿瘤医院/辽宁省肿瘤医院妇科,辽宁沈阳110042 [5]安阳市肿瘤医院妇瘤科,河南安阳455000 [6]北京医院妇产科,北京100005 [7]山西医科大学附属第二医院妇产科,山西太原030001 [8]广州医科大学公共卫生学院,广东广州511436 [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》2021年第11期1147-1151,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);广州市科技计划(158100075);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD019)。

摘　　要：目的探讨2018年FIGO子宫颈癌新分期中ⅡA2期治疗策略。方法基于中国子宫颈癌临床诊疗项目大数据库,对47家医院于2004—2018年期间收治的1112例FIGO 2018ⅡA2期子宫颈癌病例,在真实世界研究条件下比较开腹广泛性子宫切除手术(ARH组)、新辅助化疗后行手术治疗(NACT组)、根治性放化疗(R-CT组)3种治疗方式的5年总体生存率(OS)及无瘤生存率(DFS)。结果(1)从数据库中共筛选出ARH组471例,NACT组342例,R-CT组299例,中位随访时间45个月。(2)单因素分析结果,ARH组与NACT组5年OS和5年DFS差异无统计学意义(93.6%vs.90.3%,P=0.068;90.0%vs.84.5%,P=0.123);ARH组、NACT组肿瘤学结局均优于R-CT组(ARH vs.R-CT 5年OS:93.6%vs.71.8%,P<0.001;5年DFS:90.0%vs.69.4%,P<0.001;NACT vs.R-CT 5年OS:90.3%vs.71.8%,P<0.001;5年DFS:84.5%vs.69.4%,P<0.001)。(3)多因素分析结果,R-CT组是影响子宫颈癌患者死亡及复发/死亡的独立危险因素。结论对于FIGO 2018ⅡA2期子宫颈癌患者,直接开腹手术或新辅助化疗后手术可能是更好的选择。Objective To explore the treatment strategy for FTGO 2018 new stageⅡA2 of cervical cancer.Methods Based on the big data databases of clinical diagnosis and treatment project for cervical cancer in China,1112 cases of FIGO 2018ⅡA2 cervical cancer admitted to 47 hospitals from 2004 to 2018 were analyzed.The 5-year OS and 5-year DFS of the three treatment regimens-direct open extensive hysterectomy(ARH group),neoadjuvant chemotherapy(NACT group)and radical radiochemotherapy(R-CT group)were compared in real world conditions.Results(1)A total of 471 cases in the ARH group,342 cases in the NACT group and 299 cases in the R-CT group were selected from the 1538 project database,and the median follow-up was 45 months.(2)Univariate analysis showed that 5-year OS and 5-year DFS were not significantly different between the ARH group and the NACT group(93.6%vs.90.3%,P=0.068;90.0%vs.84.5%,P=0.123).The tumor outcomes in the ARH and NACT groups were better than those in the RCT group(for ARH vs.R-CT,5-year OS:93.6%vs.71.8%,P<0.001;5-year DFS:90.0%vs.69.4%,P<0.001),(for NACT vs.R-CT,5-year OS:90.3%vs.71.8%,P<0.001;5-year DFS:84.5%vs.69.4%,P<0.001).(3)Multivariate analysis showed that the R-CT group was an independent risk factor for death and recurrence/death of patients with cervical cancer.Conclusion For FIGO 2018 stageⅡA2 cervical cancer,direct open surgery or surgery after neoadjuvant chemotherapy may be better options.

关 键 词：子宫颈肿瘤 国际妇产科联盟 治疗策略 

分 类 号：R737.3[医药卫生—肿瘤]