新辅助顺铂联合化疗在宫颈鳞癌治疗中的作用

A study of neoadjuvant chemotherapy based on cisplatin in treatment of squamous carcinoma of uterine cervix

目的 评价顺铂联合化疗在宫颈鳞癌治疗中的作用。方法 将 5 4例ⅠB2 ～ⅡB 期宫颈鳞癌随机分为 2组 ,2 6例采用新辅助化疗后手术 ,2 8例直接手术 ,评价术前化疗的疗效 ,比较两组的 2年及 5年生存率和平均生存时间。结果 新辅助化疗后宫颈局部病灶缩小和宫旁改善总有效率为 84 6 % (2 2 2 6 )。新辅助化疗组与未化疗组的 2年生存率分别为 80 8% (2 1 2 6 )和 82 1%(2 3 2 8) (P >0 9) ,5年生存率分别为 73 1% (19 2 6 )和 5 7 1% (16 2 8) ,无显著性差异 (P <0 2 5 )。两组的平均生存时间分别为 5 9 3个月和 4 8 8个月 (P <0 0 5 ) ;化疗组中ⅠB2 ～ⅡA 期平均生存时间为 6 5 4个月 ,与非化疗组 4 9 8个月相比提高 15 6个月 ,有显著性差异 (P <0 0 5 )。两组病例手术的术中出血、手术时间、术后尿管留置时间均无显著差异。结论 新辅助化疗能有效控制宫颈病灶 ,改善宫颈鳞癌患者的预后。

Objective To evaluate the efficacy of neoadjuvant chemotherapy based on cisplatin for squamous carcinoma of the uterine cervix.Methods From 1996 to 1998,54 patients with stage Ⅱ B2 ～Ⅱ B of the uterine cervix squamous carcinoma in Chongqing cancer hospital were randomized into group A or group B.Group A(26 cases)received neoadjuvant chemotherapy before radical hysterectomy with pelvic lymphadenectomy.Group B(28 cases)only received radical hysterectomy with pelvic lymphadenectomy.After a 5-year follow up,we compare 2 and 5-year survival rates and average survival time of two groups.Results The response rate to the neoadjuvant chemotherapy is 84.6%(22/26).The 2-year survival rates of group A and group B are 80.8%(21/26)and 82.1%(23/28)respectively.Their 5-year survival rates are 73.1%(19/26)and 57.1%(16/28)respectively(P<0.25).The average survival time of the 2 groups are 59.3 months and 48.8 months respectively(P<0.05).The average survival time of the stage Ⅰ B2 ～Ⅱ A patients of group A is 65.4 months,15.6 months longer than group B(P<0.05).There are no significant differences in the average operation time,bleeding in operation and the preserved time of installing catheter after operation between the two groups.Conclusion Neoadjuvant chemotherapy for squamous carcinoma of the uterine cervix can reduce focus significantly and improve prognosis for patients.