局部晚期子宫颈癌手术前新辅助化疗的近期和远期疗效分析

Response to neoadjuvant chemotherapy on locally advanced cervical cancer and long-term follow-up outcome

目的 探讨手术前新辅助化疗对于局部晚期子宫颈（简称宫颈）癌疗效的影响及预后相关因素.方法 对2005年1月至2006年12月中山大学附属肿瘤医院收治的139例局部晚期（肿瘤≥4 cm）宫颈癌病例进行回顾性分析,根据术前是否行新辅助化疗分为两组,新辅助化疗（NAC）组117例,其中Ⅰ B期84例,Ⅱa期33例,术前行1～3疗程化疗,化疗结束后3周评价NAC的疗效,并接受根治性手术.直接手术（DOR）组22例,其中Ⅰ B期18例,Ⅱa期4例.两组病例均根据术后是否有高危因素,给予化疗和（或）放疗.结果 新辅助化疗后达完全缓解（CR）16例,部分缓解（PR）68例,有效率为71.8%.PR患者的死亡风险是CR患者的28.82倍,其中12例达到病理CR的患者,复发率及病死率均为0.中位随访时间50个月,NAC组无进展生存期（55.36±2.16）个月,3年生存率82.1%,复发率26.5%,平均复发时间（11.06±9.50）个月.DOR组无进展生存期（61.64±3.63）个月,3年生存率90.9%,复发率9.1%,平均复发时间（12.50±7.78）个月.比较两组的无进展生存期、总生存期、复发率及3年生存率,其差异均无统计学意义（均P＞0.05）.对NAC组的单因素分析结果提示,肿瘤细胞分化程度、肿瘤浸润深度、对化疗的反应性及淋巴结转移对预后有影响,多因素分析结果提示仅淋巴结转移为独立的预后不良因素.结论 术前新辅助化疗似未能明显改善局部晚期宫颈癌患者的预后.淋巴结转移是影响预后的重要因素.宫颈癌患者手术前新辅助化疗的近期疗效如果能达到病理完全缓解,提示死亡风险下降.

Objective To assess the efficacy of neoadjuvant chemotherapy and the prognostic factors in patients with locally advanced cervical cancer. Methods From January 2005 to December 2006,139 patients with stage Ⅰb-Ⅱa bulky cervical cancer （tumor diameter ≥4 cm） treated at our department were enrolled into this retrospective study. The patients were divided into two groups of neoadjuvant chemotherapy （NAC） （n = 117） and director operation （DOR） （n = 22）. In NAC group, 84 with stage Ⅰ b and 33 with stage Ⅱ a disease received radical hysterectomy and lymphadenectomy after 1-3 cycles of neoadjuvant chemotherapy. In DOR group, 18 with stage Ⅰ b and 4 with stage Ⅱ a disease underwent radical hysterectomy directly after diagnosis. The high-risk patients in both groups received chemotherapy and/or radiotherapy according to the post-operative pathological results. All patients were followed up routinely to assess the prognosis. Results Eighty-four patients achieved complete remission （CR） or partial remission （PR） after NAC administration. And the response rate for NAC was 71.8%. The death risk in PR cases was 28. 82 times higher than that in CR cases. None of 12 patients with a pathologically complete remission developed recurrence or death. The median follow-up duration was 50 months for all cases. In NAC group,the disease-free survival time was（55.36 ± 2. 16） months and the 3-year survival rate was 82. 1%. The recurrent rate was 26. 5% while the average recurrent time of （11.06 ±9. 50） months. In DOR group, the above parameters were（61.64 ±3.63） months, 90. 9% , 9. 1% and（ 12. 50 ±7.78） months respectively.There were no significant difference between two groups in these prognosis parameters （all P 〉0. 05）.Univariate analysis revealed that histological grade,deep cervical invasion,response to neoadjuvant chemotherapy and lymph node metastasis were the risk factors for prognosis in patients on NAC. The COX hazard analysis indicated that lymph node metastasis was only independent prognostic factor. Conclusion Neoadjuvant chemotherapy appears not to offer any advantage of improving the prognosis in locally advanced cervical cancer. The lymph node metastasis is an important prognostic factor. The patients with a pathological complete remission after NAC may have a good prognosis.