摘要
目的比较分析术前接受新辅助化疗联合腔内放疗、单纯新辅助化疗或单纯腔内放疗3种新辅助治疗方式的Ⅰb2期和Ⅱa2期宫颈癌患者的临床效果。方法回顾性分析2000年1月至2009年12月中国医学科学院肿瘤医院收治的接受新辅助治疗联合手术治疗的Ⅰb2期和Ⅱa2期宫颈癌患者共224例的资料，根据其术前新辅助治疗方式的不同分为3组，新辅助化疗联合腔内放疗组（化疗联合放疗组）86例、单纯新辅助化疗组（化疗组）48例、单纯腔内放疗组（放疗组）90例，比较3组患者的疗效（以完全缓解＋部分缓解为有效）、术后危险因素、术后辅助治疗和生存情况。结果化疗联合放疗组、化疗组、放疗组患者的有效率分别为62％（53／86）、42％（20／48）和37％（33／90），3组间比较，差异有统计学意义（P=0．003）。3组患者间宫颈间质浸润深度、淋巴结转移、脉管瘤栓及其他术后危险因素（指除局部肿瘤直径〉4cm外的危险因素）个数比较，差异均无统计学意义（P〉0．05）。其中，化疗联合放疗组患者中宫颈间质浸润深度≥1／2的比例明显低于化疗组[分别为53％（46／86）和73％（35／48），P=0．027]，淋巴结转移阳性的比例明显低于放疗组[分别为17％（15／86）和29％（26／90），P=0．046]，无其他术后危险因素的比例明显高于化疗组[分别为44％（38／86）和25％（12／48），P=0．028]。化疗联合放疗组、化疗组、放疗组患者中接受术后辅助治疗的比例分别为47％（40／86）、67％（32／48）和62％（56／90），3组间比较，差异有统计学意义（P=0．035）。化疗联合放疗组、化疗组、放疗组患者的5年无瘤生存率分别为79％、75％和78％，5年总生存率分别为81％、78％和81％，3组间分别比较，差异均无统计学意义（P〉0．05）。224例患者中，其他术后危险因素个数分别为0、1、≥2个患者的5年无瘤生存率分别为90％、75％和57％，5年总生存率分别为95％、82％和65％，3者间分别比较，差异均有统计学意义（P〈0．01）；无其他术后危险因素的患者中是否接受术后辅助放疗的5年总生存率分别为89％和96％，两者比较，差异无统计学意义（P=0．263）。结论Ib2期和Ⅱa2期宫颈癌术前接受新辅助化疗联合腔内放疗、单纯新辅助化疗和单纯腔内放疗患者的5年无瘤生存率和5年总生存率均无差异，新辅助治疗联合手术治疗后无其他术后危险因素的患者预后较好。
Objective To compare the clinical efficacy of neoadjuvant chemotherapy plus vaginal intracavitary irradiation, neoadjuvant chemotherapy alone and vaginal intracavitary irradiation alone followed by radical hysterectomy in patients with stage Ⅰ h2 and Ⅱ a2 bulkly cervical carcinoma. Methods Between January 2000 and December 2009, 224 patients with stage Ⅰ b2 and Ⅱ a2 bulkly cervical carcinoma （ tumor diameter 〉 4 cm） received neoadjuvant therapy combined surgery in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences were respectively analyzed, and they were divided into 3 groups according to the preoperative neoadjuvant therapy, the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group （chemotherapy combined irradiation group, n = 86 ）, the neoadjuvant chemotherapy alone group （chemotherapy group, n = 48 ）, the vaginal intracavitary irradiation alone group （irradiation group, n =90）. The efficacy, postoperative risk factors, postoperative adjuvant therapy and survival were compared among the 3 groups. Results Among the chemotherapy combined irradiation group, chemotherapy group and irradiation group, the response rate （RR） were respectively 62% （53/86）, 42% （20/48） and 37% （33/90） , and there was significant difference （P = 0. 003 ）. The comparison of deep stromal invasion, lymph node metastases, lympho-vascular space involvement （LVSI） and other risk factors among the 3 groups, which showed that there were no statistically significant differences （ P 〉 0. 05 ）. In chemotherapy combined irradiation group, the percentage of stromal invasion /〉 1/2 was lower than that in chemotherapy group [ 53% （46/86） vs. 73% （35/48）, P = 0. 0271, and the percentage of lymph node metastases was significantly lower than irradiation group [ 17% （15/86） vs. 29% （26/90）, P = 0. 046 ], and the risk factors-free rate was significantly higher than chemotherapy group [ 44% （38/86）vs. 25 % （ 12/48 ）, P = 0. 028 1. Among the chemotherapy combined irradiation group, chemotherapy group and irradiation group, the percentage of postoperative radiation therapy were respectively 47% （40/86）, 67% （32/48）and 62% （ 56/90 ）, and the differences were statistically significant （ P = 0. 035 ）. The five-year disease free survival （DFS） was 79%, 75% and 78%, respectively. The five-year overall survival （OS） was respectively 81%, 78% and 81% among 3 groups, and there were no statistically significant differences （P 〉 0. 05）. Among 224 patients, the five-year DFS of the patients with 0, 1 and I〉 2 risk factors after surgery were 90%, 75% and 57%, and OS were 95%, 82% and 65%, and there were no statistically significant differences（P 〈 0. 01, respectively）. Of patients without postoperative risk factors, the five-year OS in those without receiving postoperative radiation therapy was 96%, while 89% in received postoperative radiation therapy patients, there were no statistically significant differences （P = 0. 263）. Conclusion There are no differences of DFS and OS among the neoadjuvant chemotherapy combined vaginal intracavitary irradiation group, the neoadjuvant chemotherapy alone group and the vaginal intracavitary irradiation alone group patients with stage Ⅰ b2 and Ⅱ a2. Patients without risk factors after neoadjuvant therapies have better prognosis.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第6期452-457,共6页
Chinese Journal of Obstetrics and Gynecology
关键词
宫颈肿瘤
肿瘤分期
化学疗法
辅助
近距离放射疗法
Uterine cervical neoplasms
Neoplasm staging
Chemotherapy, adjuvant
Brachytherapy
