紫杉醇联合铂类新辅助化疗治疗局部晚期宫颈癌的临床研究

Clinical research of Paclitaxel plus platinum neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer

目的 研究紫杉醇联合铂类新辅助化疗治疗局部晚期宫颈癌的效果,评价紫杉醇联合铂类新辅助化疗的安全性。方法 选取首都医科大学附属北京妇产医院2010年1月-2015年1月就诊的局部晚期宫颈癌患者144例为研究对象,根据治疗方式的不同将其分为对照组（n=74）和研究组（n=70）。其中对照组直接行根治性手术治疗,研究组给予紫杉醇联合铂类新辅助化疗联合根治性手术治疗。比较两组术后病理特征、术中出血、术后并发症及近期疗效情况,观察新辅助化疗的疗效及副作用。结果 术前评估局部瘤灶变化,研究组患者完全缓解率达18.6%,部分缓解率达81.4%,术后病理完全反应率达10.0%。研究组术后深层间质浸润发生率（51.4%）明显少于对照组（74.3%）,差异有高度统计学意义（P〈0.01）,子宫旁浸润率（2.9%）、脉管间隙癌栓率（38.6%）及术后淋巴囊肿发生率（15.7%）均低于对照组（12.2%、44.6%、17.6%）,但差异无统计学意义（P〉0.05）。研究组与对照组的近期复发率（2.9%比5.4%）及病死率（1.4%比2.7%）比较,差异均无统计学意义（P〉0.05）。研究组患者新辅助化疗期间,未出现严重不良事件,仅1例患者出现Ⅲ度骨髓抑制。结论 紫杉醇联合铂类新辅助化疗治疗局部晚期宫颈癌联合手术较直接手术有更好的近期疗效,其安全性是肯定的。

Objective To study the curative effect of Paclitaxel plus platinum neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer, and evaluate the safety of Paclitaxel plus platinum neoadjuvant chemotherapy. Methods 144 patients with locally advanced cervical cancer from January 2010 to January 2015 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected as study objects, and they were divided into two groups according to the different methods of treatment, 74 cases of the control group were accepted radical surgery directly, 70 cases of the experimental group accepted Paclitaxel plus platinum neoadjuvant chemotherapy combined radical surgery. The postoperative pathological characteristics, intraoperative bleeding, postoperative complications and the short-term curative effect were observed between the two groups; the side effects and curative effect of neoadjuvant chemotherapy were observed. Results Size of local tumor of patients in the experimental group was evaluated before operation, the overall complete response rate was 18.6%, the partial remission rate was 81.4%, postoperative pathological complete response rate was 10.0%. Postoperative deep stromal infiltration rate of the experimental group（51.4%） was significantly lower than that of the control group（74.3%）, the difference was statistically significant（P〈0.01）, parametial invasion rate and lymphovascular space invasion rate and incidence rate of lymphocele postoperation of the experimental group（2.9%, 38.6%, 15.7%） were lower than those of the control group（12.2%, 44.6%, 17.6%）, but had no statistically significant difference（P〉0.05）.The experimental group and the control group had nearly recurrence rate（2.9% vs 5.4%） and mortality（1.4%vs 2.7%） had no statistically significant difference（P〉0.05）. During the period of neoadjuvant chemotherapy,no serious adverse events occurred in experimental group, only 1 case patients appeared Ⅲ-degree bone marrow suppression. Conclusion There is better short-term effects of Paclitaxel plus platinum neoadjuvant chemotherapy in the treatment of locally advanced cervical cancer, compared with direct operation, and has confirmed security.