Ⅰb2／Ⅱa期宫颈癌56例新辅助化疗后病理观察及疗效评价

Histological evaluation of cervical carcinomas in FIGO stage Ⅰb2/Ⅱa after neoadjuvantchemotherapy

目的研究宫颈癌新辅助化疗（NACT）后病理形态改变及对病理诊断的影响，评价宫颈癌化疗组织学疗效评判标准。方法对56例Ⅰb2／Ⅱa期局部晚期宫颈癌患者NACT手术前后病理切片进行形态观察和组织学疗效评价，并与影像学／妇科检查对化疗疗效评价结果进行比较。结果56例局部晚期宫颈癌患者NACT后组织学3级／重度改变11例（19．6％），2级／中度改变24例（42．9％），l级／轻度改变13例（23．2％），0级／无变化8例（14．3％）。组织学评价总有效率62．5％（35／56），影像学／妇科检查评价总有效率67．9％（38／56），组织学与影像学／妇科检查有效符合30例，无效符合14例，总符合率78．6％（44／56）。组织学有效、影像学／妇科检查无效4例（7．1％，4／56），组织学无效、影像学／妇科检查有效8例（14．3％，8／56）。化疗有效病例癌组织呈现从密集、拥挤、生长活跃到变性、坏死、稀疏，消融、结构逐渐恢复正常的特点。结论宫颈癌患者NACT后大部分病例有明显的病理形态改变，影响术后病理诊断，组织学疗效评价与影像学／妇科检查评价存在一定差异，推荐采用宫颈癌组织学疗效评价标准。

Objective To investigate the histological changes of cervical cancer after neoadjuvant chemotherapy （NACT） and to establish histological criteria for interpretation of chemotherapeutical effects. Methods Fifty-six patients with FIGO stage Ⅰb2- Ⅱ a cervical cancers treated by NACT and subsequent radical surgery were retrospectively analyzed, in which the pre- and post-chemotherapeutic histopathological changes were assessed. Results The post-chemotherapeutic histopathological changes of 56 cases included grade 3 effects in 11 eases （19. 6% ） , grade 2 in 24 eases （42. 9% ） , grade 1 in 13 cases （23. 2% ） and no response in only 8 eases （14. 3% ）. The histologie response rate was 62.5% （35/56） and the overall clinical response rate was 67. 9% （38/56）. The overall coincidence by both criteria was 78.6% （44/56）. Four cases （7. 1% , 4/56） had only histological response and 8 eases （ 14. 3% , 8/56） had response by imaging. In comparison with the pre-chemotherapy specimens, the chemotherapy-associated histological changes included shrinkage and scattering of tumor nests, decrease of tumor cellularity, tumor cell degeneration and necrosis. Conclusions The histologieal changes in locally advanced eervieal cancers induced by NACT are signifieant, which may challenge the diagnosis in the final specimens. There are some discreqancies between the histological criteria and imaging/gynecological ones for the therapeutic evaluation of cervical cancers,and it is thus recommended to use the pathological criteria for clinic practice.