术前新辅助化疗在宫颈癌行手术治疗患者中的应用

doi:10.3760/cma.j.issn.1673-422X.2017.10.007

摘要/Abstract

摘要： 目的探究术前新辅助化疗对局部晚期宫颈癌手术患者的临床效果。方法选择2010年3月至2013年11月在我院欲行宫颈癌根治术的284例ⅠB2期及ⅡA2期宫颈癌患者，根据患者意愿分为实验组172例和对照组112例，实验组术前采用新辅助化疗（紫杉醇联合奥沙利铂），对照组单纯手术治疗。评价实验组化疗效果，并比较两组手术时间、术中出血量、术后辅助治疗率、切缘阳性率、病理特征、总生存率（OS）和无复发生存率（RFS）的差异。结果实验组新辅助化疗有效率为76.74%（132/172），其中ⅠB2患者有效率为82.80%（77/93），ⅡA2患者有效率为69.62%（55/79），差异有统计学意义（χ2=4.155，P=0.042）。实验组手术时间为（231.71±29.04）min，较对照组的（253.12±30.97）min明显缩短（t=5.914，P<0.001），实验组术后辅助治疗率显著低于对照组（61.05%∶76.79%，χ2=7.630，P=0.006），而两组术中出血量差异没有统计学意义［（614.33±120.19）ml∶（622.84±131.27）ml，t=0.562，P=0.574］，且两组均无阴道切缘阳性病例。实验组术后宫颈间质深层浸润率（χ2=6.752，P=0.009）、宫旁转移率（χ2=4.359，P=0.037）、脉管浸润率（χ2=5.310，P=0.021）、颈管累及率（χ2=11.022，P<0.001）和淋巴结转移率（χ2=6.830，P=0.009）均显著低于对照组。对照组和实验组的中位随访时间分别为31.5（4.5～42.0）个月和33.4（4.5～42.0）个月，两组患者3年RFS（52.68%∶60.47%，HR=0.746，95%CI为0.507～1.067，P=0.109）和OS（79.46%∶81.40%，HR=0.732，95%CI为0.436～1.203，P=0.214）差异无统计学意义。结论宫颈癌患者术前新辅助化疗治疗效果良好，可显著缩短手术时间，改善术后病理特征，降低淋巴结转移率，但不能显著降低远期肿瘤复发率或提高远期生存率。

关键词: 宫颈肿瘤, 新辅助化疗, 临床效果, 生存率

Abstract: ObjectiveTo explore the clinical effect of preoperative neoadjuvant chemotherapy on locally advanced cervical cancer. MethodsFrom March 2010 to November 2013, 284 cases of stage ⅠB2 and stage ⅡA2 cervical cancer who underwent radical operation in our hospital were divided into experimental group (n=172) and control group (n=112) according to the patients′ will. The experimental group was treated by neoadjuvant chemotherapy (paclitaxel combined with oxaliplatin) before surgery, while the control group was treated by surgery alone. The effect of chemotherapy of experimental group was evaluated, and the operative time, blood loss, adjuvant therapy rates after operation, positive rates of resection margin, pathological characteristics, overall survival (OS) and relapse free survival (RFS) of the two groups were compared. ResultsThe effective rate of neoadjuvant chemotherapy was 76.74% (132/172), while the effective rate in ⅠB2 patients was 82.80% (77/93) and in ⅡA2 patients was 69.62% (55/79), with a statistically significant difference (χ2=4.155, P=0.042). The operation time of experimental group ［(231.71±29.04) min］ was shorter than that of control group ［(253.12±30.97) min, t=5.914, P<0.001］. The adjuvant therapy rate after operation of experimental group was lower than that of control group (61.05% vs. 76.79%, χ2=7.630, P=0.006). There was no significant difference in bleeding volume between the two groups ［(614.33±120.19) ml vs. (622.84±131.27) ml, t=0.562, P=0.574］, and there were no positive cases of vaginal incision in the two groups. The rates of deep cervical stromal invasion (χ2=6.752, P=0.009), parametrial metastasis (χ2=4.359, P=0.037), vascular infiltration (χ2=5.310, P=0.021), cervical canal involving (χ2=11.022, P<0.001) and lymph node metastasis (χ2=6.830, P=0.009) of experimental group were significantly lower than those of control group. The median followup was 31.5 (4.542.0) months and 33.4 (4.542.0) months in control and experimental group. There were no significant differences in 3year RFS (52.68% vs. 60.47%, HR=0.746, 95%CI: 0.5071.067, P=0.109) and 3year OS (79.46% vs. 81.40%, HR=0.732, 95%CI: 0.4361.203, P=0.214) between the two groups. ConclusionThe preoperative neoadjuvant chemotherapy is effective for patients with cervical cancer. It can shorten the operation time, improve the pathologic features and decrease the lymph node metastasis rate. But it can not significantly reduce the longterm recurrence rate or improve the longterm survival rate.

Key words: Cervical neoplasms, Neoadjuvant chemotherapy, Clinical effect, Survival rate

陈悦,肖苏,潘伟. 术前新辅助化疗在宫颈癌行手术治疗患者中的应用 [J]. 国际肿瘤学杂志, 2017, 44(10): 749-753.

Chen Yue, Xiao Su, Pan Wei. Application of preoperative neoadjuvant chemotherapy in cervical cancer patients undergoing surgical treatment[J]. Journal of International Oncology, 2017, 44(10): 749-753.

参考文献

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