子宫动脉化疗栓塞与髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效对比

Comparison of uterine artery chemoembolization and internal iliac arterial infusion chemotherapy for the combining treatment for women with locally advanced cervical cancer

背景与目的:子宫动脉化疗栓塞与髂内动脉灌注化疗是临床治疗宫颈癌的重要方法,两者疗效有无差异尚无定论。本研究比较子宫动脉化疗栓塞和髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效。方法:将1997年4月至2007年11月间收治的175例局部晚期宫颈癌患者分为两组。子宫动脉化疗栓塞组92例,双侧子宫动脉插管注药后行双侧子宫动脉栓塞,65例行子宫颈癌根治术,其中37例术前采用192Ir高剂量率腔内后装放疗。髂内动脉灌注化疗组83例,采用双侧髂内动脉插管注药,70例行子宫颈癌根治术,其中34例术前采用同样的腔内后装放疗。两组化疗方案均为以铂类为主的联合方案。根据术后病理结果,对51例有病理危险因素的患者加用外放射治疗。结果:子宫动脉化疗栓塞组总有效率为64.1%,明显高于髂内动脉灌注化疗组(47.0%,P=0.023)。子宫动脉化疗栓塞组ⅠB期患者的肿瘤缩小有效率(77.8%)明显高于髂内动脉灌注化疗组(41.2%,P=0.037),两组Ⅱ、Ⅲ期患者的总有效率差异无统计学意义(P=0.137和P=0.524)。术后病理结果显示,子宫动脉化疗栓塞组癌细胞阴性率、盆腔淋巴结转移阴性率、无复发率均略高于髂内动脉灌注化疗组,但差异无统计学意义(P>0.05);而脉管癌栓阴性率略低于髂内动脉灌注化疗组(P=0.072)。子宫动脉化疗栓塞组1、3、5年总生存率与髂内动脉灌注化疗组相比差异无统计学意义(P=0.665)。结论:子宫动脉化疗栓塞联合术前放疗可有效缩小局部晚期宫颈癌的肿瘤体积,但不能增加病理完全缓解率、不能减少淋巴结转移和术后复发,控制脉管癌栓略差于髂内动脉灌注化疗,对远期生存率尚未显示出优势,有待进一步长期随访。

Background and Objective： Uterine artery chemoembolization （UACE） and internal lilac arterial infusion chemotherapy （IAIC） are important methods to treat cervical cancer. However, whether the curative efficacy of the two methods has difference is not clear. This study was to evaluate the curative effects of UACE and IAIC on the combining treatment for women with locally advanced cervical cancer. Methods： One hundred and seventy-five patients with locally advanced cervical cancer treated between April 1997 and November 2007 were retrospectively analyzed. Patients were divided into two groups： the UACE group （n=92） and the IAIC group （n=83）. The UACE group was treated by bilateral uterine artery chemoembolization. Sixty-five of them underwent radical hysterectomy two weeks after UACE, 37 of which received ^192Ir high-dose-rate intracavitary radiotherapy 1-2 weeks before radical hysterectomy. The IAIC group was treated by bilateral internal lilac arterial infusion chemotherapy. Among them 70 patients underwent radical hysterectomy after IAIC, 34 of which received ^192Ir high-dose-rate intracavitary radiotherapy 1-2 weeks before radical hysterectomy. All patients were treated by carboplatin-based combining chemotherapy. Radiotherapy was performed on 51 requisite patients with high risk of pathological conditions after radical surgery. Results： The tumor regression rate of the UACE group was 64.1%, which was significantly higher than 47.0% in the IAIC group （P=0.023）. The effective rate for clinical stage tB cervical cancer in the UACE group was 77.8%, which was significantly higher than 41.2% in the tAlC group （P= 0.037）. However, for clinical stage Ⅱ , Ⅲ cervical cancer, the effective rates between the two groups had no significant differences （P=0.137 and P= 0.524）. Postoperative pathologic examinations showed that the negative percentages of cancer cell residue and pelvic lymph node metastasis in the UACE group were slightly higher than those in the IAIC group （17.2% and 80.6% vs. 12.9% and 79.4%, P=0.504 and P=0.861）. The recurrent rate in the UACE group was slightly lower than that in the IAIC group （25% vs. 26.5%, P=0.820）. The negative percentage of tumor embolus within lymphovascular space was lower in the UACE group than in the IAIC group （87.3% vs. 97.1%, P=0.072）. The 1,3,5-year overall survival rates in the UACE group and the IAIC group were 95%, 81%, 77% and 91%, 79%, 71%, respectively （P=0.665）. Conclusions： UACE followed by preoperative radiotherapy can more effectively reduce the tumor volume of locally advanced cervical cancer compared with IAIC. But UACE does not increase the pathological complete response rate and not decrease the pelvic lymph node metastasis rate, the postoperative recurrence rate, and tumor embolus within lymphovascular space. The effect of UACE on the long-term survival of locally advanced cervical cancer needs to be further evaluated.