新辅助化疗在宫颈癌治疗中的疗效分析

Effect of Neoadjuvant Chemotherapy on Cervical Cancer

目的:探讨新辅助化疗在宫颈癌临床治疗中的作用。方法:以170例宫颈癌病例(Ⅰb～Ⅳ期)为新辅助化疗试验组,同期同条件未经新辅助化疗的160例病例为对照组进行回顾性分析。按其治疗方法将研究病例分为6组,两两配对:NS组(新辅助化疗+手术)与S组(单纯手术);NSR组(新辅助化疗+手术+放疗)与SR组(单纯手术+放疗);NR组(新辅助化疗+放疗)与R组(单纯放疗);进行配对组间比较。结果:新辅助化疗的总有效率为70%。NS组的1、3及5年生存率分别为87%、81%和81%;对照S组的为97%、93%和93%(P均>0.05);两组生存曲线无显著性差异(P=0.685)。NSR组的1、3及5年生存率分别为100%、93%和93%;对照SR组的为100%、100%和92%(P均>0.05);两组生存曲线无显著性差异(P=0.351)。NR组的1、3及5年生存率分别为76%、45%和36%;对照R组的为81%、54%和37%(P均>0.05);两组生存曲线无显著性差异(P=0.723)。各组新辅助化疗的不良反应以胃肠道反应为主,患者均可耐受。结论:在宫颈癌治疗中,新辅助化疗虽然不能显著提高宫颈癌患者的生存率,但仍是一种安全的、有较好近期疗效的治疗方法。

Objective： To evaluate the efficacy and toxicity of neoadjuvant chemotherapy for cervical cancer. Methods： From 1985 to 2006, 330 patients with stage Ib-IV cervical cancers were managed into six groups （three pairs）. Pair one： NS （NACT followed by surgery） compared with S （Surgery alone）; Pair two： NSR （NACT followed by surgery and adjuvant radiotherapy） compared with SR （Surgery followed by adjuvant radiotherapy）; Pair three： NR （NACT followed by radical radiotherapy） compared to R （Radical radiotherapy alone）. Results： Overall effective rate of NACT was 70%. Pair one： The patient survival rates at 1, 3, and 5 years were 87%,81%, and 81% （NS） versus 97%, 93% and 93%（S）, respectively （P 〉 0.05）. Pair two： The patient survival rates at 1, 3, and 5 years were 100%, 93%, and 93% （NSR） versus 100%, 100% and 92% （SR）, respectively （P 〉 0.05）. Pair three： The patient survival rates at 1, 3, and 5 years were 76%, 45%, and 36% （NR） versus 81%, 54% and 34% （R）, respectively （P 〉 0.05）. No significant differences were found in survival curves among these three pairs. The most common adverse reactions were gastrointestinal reactions. Conclusion： NACT is effective for cervical cancer but with no benefit for overall survival.