Ⅰb2～Ⅱa期宫颈癌根治性子宫切除术前子宫动脉栓塞化疗及髂内动脉前干支化疗的疗效比较

Therapeutic comparison of uterine artery chemoembolization with internal iliac anterior trunk arterial chemotherapy performed before radical hysterectomy in patients with stages Ⅰb2-Ⅱa cervical cancer

目的探讨Ⅰb2～Ⅱa期宫颈癌根治性子宫切除术前不同动脉化疗方式的近期及远期疗效。方法将151例患者分为研究组和对照组,研究组113例采取子宫动脉栓塞化疗术,对照组38例采取髂内动脉前干支化疗,术后2～4周内行根治性子宫切除术,观察化疗后2周内肿瘤变化及根治性子宫切除术后2、5年生存率。结果介入术前测量肿瘤最大径平均为(4.58±0.37)cm,介入术后最大径平均值(2.11±0.24)cm。在研究组和对照组完全有效率分别为31.9%和21.1%;总有效率为94.7%(107/113)和76.3%(29/38),2周内疗效研究组明显好于对照组(P值均<0.01)。两组手术切缘均未见癌浸润,研究组3例切缘见脉管转移,5例见宫旁浸润,盆腔淋巴结转移6例;对照组1例切缘脉管转移,2例宫旁浸润,1例盆腔淋巴结转移。研究组2年生存为68/84,5年生存为47/64;对照组2年生存26/32,5年生存18/24。两组2年及5年生存率比无明显差异(P值均>0.05)。结论子宫动脉化疗栓塞术短期内使宫颈癌肿瘤明显缩小,有利于外科手术剥离,近期疗效好于髂内动脉前干化疗,远期疗效无差异,是Ⅰb2～Ⅱa期宫颈癌的首选新辅助动脉化疗方式。

Objective To compare the short-term and long-term therapeutic response of uterine artery chemoembolization with internal iliac anterior trunk arterial chemotherapy performed before radical hysterectomy in patients with stages Ⅰb2-Ⅱa cervical cancer.Methods One hundred and fifty-one patients with stages Ⅰb2-Ⅱa cervical cancer were treated with preoperative intra-arterial chemotherapy before radical hysterectomy was carried out.Patients in study group（n = 113） received uterine artery chemoembolization（UACE）,while patients control group（n = 38） received internal iliac anterior trunk arterial chemotherapy.Radical hysterectomy was carried out in all patients within 2-4 weeks after UACE or chemotherapy.The tumor size was measured before and after the procedure,and the survival rate at 2 and 5 years after treatment was calculated.Results The mean maximum diameter of the tumors was（4.58 ± 0.37） cm before interventional therapy,and it was（2.11 ± 0.24） cm in two weeks after interventional therapy.The complete response rate of study group and control group was 31.9% and 21.1% respectively.The total effective rate of study group and control group was 94.7%（107/113） and 76.3%（29/38） respectively.The effective rate of study group two weeks after therapy was significantly higher than that of control group.No surgical margin infiltration was observed in both groups.Pathological findings in study group included vascular invasion around surgical margin（n = 3）,parametrial invasion（n = 5） and pelvic lymph node metastasis（n = 6）,while in control group vascular invasion around surgical margin,parametrial invasion and pelvic lymph node metastasis were found in one,two and one cases respectively.The two-year and five-year survival rate in study group were 80.9%（68/84） and 73.4%（47/64） respectively,while the two-year and five-year survival rate in control group were 81.3%（26/32） and 75.0%（18/24） respectively.No significant difference in survival rate existed between two groups.Conclusion Uterine artery chemoembolization can markedly reduce the volume of cervical cancer,which is very helpful for surgical resection.The therapeutic effectiveness of UACE is superior to internal iliac anterior trunk arterial chemotherapy,therefore,UACE should be regarded as neo-adjuvant intra-arterial chemotherapy of first choice for patients with stages Ⅰb2-Ⅱa cervical cancer.