评价新辅助化疗用于局部晚期宫颈癌手术治疗前的临床价值

Clinical value of neoadjuvant chemotherapy in the treatment of local advanced cervical cancer

目的 评价新辅助化疗用于局部晚期宫颈癌手术治疗前的临床价值.方法 网上检索MEDLINE、PUBMED、ELSEVIER ScienceDirect、CNKI等,获取全文.筛选文献,实验组是新辅助化疗联合手术,对照组是直接手术,提取用于评价的指标包括：淋巴结转移、脉管浸润、间质浸润、切缘阳性率、3年生存率（OS）、3年无瘤生存率（DFS）、5年生存率、5年无瘤生存率,并进行Meta分析.结果 新辅助化疗组与对照组相比,淋巴结转移的HR和95%CI分别为（0.54,0.33～0.86）,间质浸润的分别为（0.45,0.24～0.86）,脉管浸润的分别为（0.25,0.16～0.38）,差异均有统计学意义（P〈0.05）;切缘阳性率的HR和95%CI分别为（0.45,0.21～0.99）,3年OS分别为（1.24,0.59～2.63）,3年DFS分别为（1.34,0.65～2.78）,5年OS分别为（0.94,0.54～1.64）,5年DFS分别为（0.99,0.71～1.93）,差异均无统计学意义（P〉0.05）.结论 局部晚期宫颈癌,新辅助化疗能减少预后不良相关病理因素,但不能改善患者的生存率.

Objectives To evaluate the clinical value of neoadjuvant chemotherapy （NACT） in the treatment of local advanced cervical cancer. Methods We searched the clinical trials on the treatment of local advanced cervical cancer with NACT followed by surgery versus initial surgery on English and Chinese published literatures from the main medical data resources （MEDLINE, PUBMED, ELSEVIER ScienceDirect, CNKI）. The data about positive pelvic nodes, interstitial infiltration, vascular invasion, positive surgical margin, 3-year overall survival （OS）, 3-year disease-free survival （DFS）, 5-year OS, 5-year DFS were extracted from these papers, and a meta-analysis was applied. Result The hazard ratio （HR） of positive pelvic nodes on NACT group versus control group was 0. 54（95% CI 0. 33 ～0. 86）, HR of interstitial infiltration was 0. 45（95% CI 0. 24 ～0. 86）, HR of vascular invasion was 0. 25（95% CI 0. 16 ～0. 38）, all differences were statistically significant. And HR of positive surgical margin was 0. 45 （ 95% CI 0. 21 ～0. 99）, P = 0. 05, which indicated the difference was not statistically significant. And there were also no significant difference on the HR of 3-year OS, 3-year DFS, 5-year OS and 5-year DFS, and their RR were 1.18（95% CI 0. 84 ～ 1.66） ,1.31 （95% CI 0. 96 ～ 1.78） ,0. 89（95% CI 0. 68 ～ 1.15） ,and 0. 99（95% CI 0. 71 ～ 1.93） respectively. Conclusion For local advanced cervical cancer, NACT could reduce pathological risk factors but it did not improve the survival.