新辅助化疗对ⅠB2～ⅡB期宫颈癌近期疗效的观察

Clinical Efficacy of Neoadjuvant Chemotherapy in StageⅠB2-ⅡB Cervical Carcinoma

目的:探讨新辅助化疗对ⅠB2～ⅡB期宫颈癌的近期疗效。方法:对哈尔滨医科大学附属第二医院2005年9月～2007年1月间ⅠB2～ⅡB期宫颈癌82例进行前瞻性研究,其中42例在根治性手术前行新辅助化疗(Neoadjuvant Chemotherapy,NACT)2～3个疗程,为NACT组,40例在术前未行新辅助化疗,为直接手术组。评价NACT组化疗疗效及影响疗效的相关因素,比较两组手术后的病理结果。结果:NACT的总有效率为76.2%,化疗效果与临床分期和分化程度无关(P>0.05),与病理类型及肿瘤的大小有关,鳞癌的有效率明显高于非磷癌(P<0.05),肿瘤直径>8cm的疗效明显低于≤8cm(P<0.05)。两组术后盆腔淋巴结阳性率及宫旁侵润率之间的差异有统计学意义(P<0.05);在NACT组中化疗有效组与无效组术后盆腔淋巴结阳性率及宫旁侵润率之间的差异有统计学意义(P<0.05)结论:新辅助化疗可改善宫颈癌的临床分期,提高宫颈癌的手术疗效,成为治疗ⅠB2～ⅡB期宫颈癌一种新手段。

Objective： To evaluate the effects ofneoadjuvant chemotherapy （NACT） followed by radical surgery on stage ⅠB2～ⅡBcervical cancer. Method： A total of 82 cases with stage ⅠB2～ⅡB cervical cancer were randomly divided into two groups according to preoperative chemotherapy： 69 cases in the NACT group who accepted 2-3 courses of chemotherapy before surgery; 71 cases in the control group who underwent radical surgery directly. The effects of NACT and the relevant factors were evaluated and the pathologic findings were compared between two groups. Result： The overall clinical response rate was 76.2%. The chemotherapeutic response was more favorable in the squamous carcinoma and the tumors smaller than 8cm （P =0.020;P =0.040）. Pathologic findings showed that the pelvic lymph node metastasis and parametrial infiltration rates were significantly lower in NACT group than in the primary surgery group （P =0.034;P =0.037）. Among patients who received NACT, the lymph node metastasis rate was still as high as 60.0% in non-NACT responders, and it decreased to 12.5% in NACT responders （P =0.006）. The same thing also occurred with parametrial infiltration： 60.0% in non-NACT responders compared with 12.5% in NACT responders （P =0.006）. Conclusion： Neoadjuvant chemotherapy can improve the clinical stage of cervical cancer and becomes a new means for stage ⅠB2～ⅡB cervical cancer ,which has a greater clinical value.