局部晚期宫颈癌新辅助化疗后病理明显缓解的25例临床分析

Clinical Pathology Acheieved Almost Complete Remission of Local Advanced Cervical Cancer after Neoadjuvant Chemotherapy:Analysis of 25 Patients

目的:通过对接受新辅助化疗的局部晚期宫颈癌患者术后病理显示明显缓解的临床特征及随访资料进行回顾性分析,初步探讨病理明显缓解患者的预后及术后治疗。方法:选择2013年1月至2015年12月新疆医科大学附属肿瘤医院妇科收治的局部晚期宫颈癌患者共计413例,其中278例术前接受了以铂类为基础的新辅助化疗2-3程,对术后病理提示>90%缓解的25例患者的病例资料进行回顾性分析。结果:(1)25例患者中,宫颈鳞状细胞癌24例,宫颈腺癌1例,中分化者18例,高分化2例,低分化者5例;术后病理显示脉管内癌栓者一例;IB2期患者的发病年龄为(37.33±2.08)岁,低于Ⅱa2/Ⅱb期患者。(2)25例患者术后均接受同手术前的化疗方案4程,随访至2017年6月,随访时间21～60个月,无一例复发或死亡,2年生存率为100%。253例病理未明显缓解患者2年生存率为82.2%,比较两组的2年生存率,其差异有统计学意义(P<0.05)。结论:宫颈癌手术前新辅助化疗如果能达到病理明显缓解,提示死亡风险下降。局部晚期宫颈癌患者对新辅助化疗的病理学反应可能可作为评估其预后的指标之一。

Objective: To explore the clinical features of received Neoadjuvant Chemotherapy(NACT) patients with locally advanced cervical cancer(LACC) which pathological results cheieved almost complete remission. Methods: From January 2013 to December 2015, 413 patients with stage Ib-IIb bulky cervical cancer(tumor diameter≥4 cm) treated at our department, 278 patients were treated with platinum-based chemotherapy before radical hysterectomy and lymphadenectomy. Among them, 25 patients were enrolled into this study. The Pathological relief rate of these patients was ≥ 90%. Results:(1) In these patients, 24 patients pathological types was squamous cell carcinoma, 1 patient was Adenocarcinoma. 18 patients were mid differentiated carcinomas, 2 patients were well differentiated carcinomas, the rest were poorly differentiate. The age of onset with stage IB2 cervical cancer mean(37.33±2.08), lower than these stage ⅡA2/ⅡB patients.(2) All 25 patients were treated with four courses of chemotherapy after surgery. Results After 21-60 months of follow-up, all did not see were obtained for recurrence and metastasis, death, the 2-year survival rate was 100%. The rest of 253 patients,the 2-year survival rate was 82.2%. There were significant difference between two groups(P <0.05). Conclusion: The patients with a pathological almost complete remission after NACT have a good prognosis. Response to NACT is a good surrogate endpoint of survival in patients with LACC.