新辅助化疗两种方式治疗局部晚期宫颈癌疗效及安全性比较

Efficacy and safety comparison between two neo-adjuvant chemotherapies in treatment of locally advanced cervical carcinoma

目的对比研究静脉化疗和介入性动脉化疗结合手术2种方式治疗局部晚期官颈癌的疗效。方法按照初始时接受治疗方法的不同，将140例局部晚期（Ⅰb2～Ⅱb期）宫颈癌患者分为实验组（介入性子宫动脉化疗＋手术）和对照组（静脉化疗＋手术）2组，各70例。观察治疗后患者的近期总有效率、治疗前后肿瘤直径变化情况、根治手术率、3年和5年生存率（OS）及无进展生存率（PFS）、并发症、病理危险因素（子宫宫旁浸润率、淋巴结转移率）发生情况。结果2组患者近期总体有效率均较高，但差异无统计学意义；实验组治疗后瘤体直径变小比对照组的更明显，其获得根治性手术机会比对照组高，相应的淋巴结转移率、子宫宫旁浸润率低于对照组；2组的3年期的生存率、无进展生存率无差异，但5年期生存率、无进展生存率实验组比对照组高。结论动脉介入途径新辅助化疗治疗局部晚期宫颈癌手术切净率、5年生存率均优于静脉化疗，是一种安全有效的治疗手段。

Objective To compare the efficacy and safety of intravenous chemotherapy plus operation and interventional arterial chemotherapy plus operation in treatment of patients with locally advanced cervical carcinoma （phases Ⅰb2- Ⅱb）. Methods 140 patients with locally advanced cervical carcinoma （phases Ⅰb2- Ⅱb） were divided into experimental group （uterine artery interventional chemotherapy plus surgery） and control group （venous chemotherapy plus surgery） according to different initial therapeutic methods, 70 cases in each group. Short-term efficacy, tumor diameter changes before and after treatment, rate of radical operation, 3 and 5 years overall survival （OS）, progression-free survival （PFS）, complications as well as pathological risk factors （rates of para-uterine invasion and lymph node metastasis） were observed. Results Short-term efficacy improved in both groups. The decreased tumor diameter in experimental group was significantly greater than control group, and the probability rate of patients with radical operation was significantly larger than the control group. Corresponding rates of para-uterine invasion and lymph node metastasis in the experimental group were significantly lower than the control group. There were no significant differences of 3 years OS and PFS between two groups, and the 5 years OS and PFS in the experimental group were higher than the control group. Conclusion For patients with locally advanced cervical carcinoma, neo-adjuvant chemotherapy with artery interventional therapy is better than intravenous chemotherapy in aspects of surgical resection rate and 5 years OS, so it is a safe and effective therapeutic method.