临床与病理杂志2017，Vol.37Issue(12)：2595-2600,6.DOI:10.3978/j.issn.2095-6959.2017.12.014
不同新辅助治疗方法联合手术治疗Ⅰb2/Ⅱa2期子宫颈鳞癌的效果分析
Effects of neoadjuvant therapies combined surgery on stage Ⅰb2/lla2 cervical squamous cell carcinoma
摘要
Abstract
Objective:To compare the clinical efficacy and safety of neoadjuvant chemotherapy alone,neoadjuvant brachytherapy alone and combination of the two methods followed by radical surgery in patients with stage Ⅰb2/Ⅱa2 cervical squamous cell carcinoma.Methods:Between Jan,2001 and Dec,2013,324 patients with stage Ⅰb2/Ⅱa2 cervical squamous cell carcinoma received neoadjuvant therapy followed by radical hysterectomy and pelvic lymph node dissection +/-para-aortic lymph node dissection in Cancer Hospital,Chinese Academy of Medical Sciences.The patients were divided into 3 groups according to the methods of neoadjuvant therapy,neoadjuvant chemotherapy alone (NAC),neoadjuvant brachytherapy alone (B) and combination of the two methods (NAC+B).Response rate (complete response + partial response),postoperative risk factors,postoperative adjuvant therapy,and survival were respectively compared among 3 groups.SPSS 24.0 was used for statistical analysis.Results:The patient number of groups NAC,B and NAC+B was 109,90 and 125,respectively.The median follow up time was 57 months.There were no statistic difference regarding age,tumor grade and growth type of cervical tumor among 3 groups (P＞0.05).No alopecia and grade 3/4 blood toxities was reported in group B.The frequency of grade 3/4 neutropenia and gastric-intestine adverse events was comparable between group NAC and NAC+B.There was no statistic difference of blood loss,surgery time and urinary injury among 3 groups.Response rates of NAC,B and NAC+B group were 55.0％,48.8％ and 60.0％,respectively (P=0.270).The percentage of postoperative risk factors in NAC,B and NAC+B group were as follows:parametria invasion 0.9％,1.1％ and 1.6％;positive margin 1.8％,1.1％ and 0％;lymph node metastasis 22.0％,28.9％ and 21.6％;lymph vascular space invasion (LVSI) 16.5％,12.2％ and 12.8％;deep stromal invasion (DSI) 58.7％,55.6％ and 51.2％,respectively (P＞0.05).Among the groups of NAC,B and NAC+B,the percentage of postoperative radiation +/-chemotherapy were 57.8％,62.2％ and 52.0％ (P=0.317).The overall 5-year disease-free survival (DFS) and overall survival rates (OS) were 87.0％ and 91.0％,respectively.Five-year DFS of these 3 groups were 92.0％,80.0％ and 86.4％,respectively (P=0.056).Five-year OS of the 3 groups were 94.0％,85.6％ and 92.0％,respectively (P=0.097).Conclusion:Patients with stage Ⅰb2/Ⅱa2 cervical squamous cell carcinoma received neoadjuvant therapy followed by radical surgery +/-postoperative radiation had good prognosis.There were no statistically significant differences of peri-operation complications,postoperative risk factors,DFS and OS among NAC,B and NAC+B groups.关键词
宫颈癌/化疗/手术/新辅助化疗/近距离放疗Key words
cervical cancer/chemotherapy/surgery/neoadjuvant therapy/brachytherapy引用本文复制引用
李宁,姚洪文,张蓉,李斌,李晓光,马绍康,吴令英..不同新辅助治疗方法联合手术治疗Ⅰb2/Ⅱa2期子宫颈鳞癌的效果分析[J].临床与病理杂志,2017,37(12):2595-2600,6.基金项目
中国医学科学院肿瘤医院科研课题(LC2012B38).This work was supported by the Clinical Research of Cancer Hospital,Chinese Academy of Medical Sciences,China (LC2012B38). （LC2012B38）
