新辅助放化疗联合手术治疗Ⅰ_(B2)～Ⅱ_(A2)期子宫颈癌临床预后因素分析

Analysis of prognostic factors in patients with stage Ⅰ_(B2)-Ⅱ_(A2) uterine cervical cancer treated with a combintion of neoadjuvant chemotherapy and surgery

背景与目的：探讨Ⅰ（B2）-Ⅱ（A2）期子宫颈腺癌与腺鳞癌经新辅助放化疗联合手术治疗后的生存及复发情况,并分析其预后影响因素。方法：收集蚌埠医学院第一附属医院2005年4月-2011年10月50例Ⅰ（B2）-Ⅱ（A2）期患者的临床病理资料。患者均接受广泛全子宫切除＋盆腔淋巴结清扫术,且术前均接受1次静脉化疗,宫颈肿瘤直径大于等于6cm,给予阴道腔内放疗1次。回顾分析患者的生存及复发情况,探讨其预后影响因素。结果：50例Ⅰ（B2）-Ⅱ（A2）期子宫颈腺癌和腺鳞癌患者中,随访期内死亡15例,2年和5年无进展生存率分别是80.12%和72.24%,中位无进展生存时间为68个月;2年和5年累积总生存率分别是95.38%和73.56%,中位总生存时间为80个月。单因素分析显示,盆腔淋巴结转移、宫颈间质浸润、宫旁浸润和新辅助放化疗后肿瘤最大直径缩短小于3cm的患者预后较差（P〈0.05）,而年龄、术后放化疗、淋巴管间隙受累分期、FIGO分期、是否保留卵巢和病理类型与预后无明显相关性（P〉0.05）。多因素COX回归分析结果显示,盆腔淋巴结转移和放化疗后肿瘤直径缩小是宫颈腺癌和腺鳞癌的独立预后影响因素。结论：新辅助放化疗联合手术治疗提高了Ⅰ（B2）-Ⅱ（A2）期宫颈腺癌和腺鳞癌手术切除率,而盆腔淋巴结转移及放化疗后宫颈肿瘤最大径消退程度是宫颈腺癌和腺鳞癌的独立预后因素。

Background and purpose： The aim of this study was to analyze the prognostic factors in uterine adenocarcinoma and adenosquamous carcinoma treated with a combination of neoadjuvant chemoradiotherapy and surgery. Methods： Clinicopathologic data from 50 patients with stage IB2-Ⅱ A2 uterine cervical cancer were collected from the First Affiliated Hospital of Bengbu Medical College between Apr. 2005 and Oct. 2011. All patients underwent neoajuvant chemoradiotherapy, followed by radical hysterectomy and pelvic lymph node dissection. Before surgery, an intravenous chemotherapy was given. A particular vaginal brachytherapy was given to those with tumor diameter 〉 6 cm. The survival and recurrence in patients were analyzed retrospectively to investigate the prognostic factors. Results： In 50 patients with IB2- Ⅱ A2 uterine adenocarcinoma and adenosquamous carcinoma, 15 died during the follow-up period. The 2-year and 5-year progression-free survival rates were 80.12% and 72.24%, respectively, and median progression-free survival was 68 months. The 2-year and 5-year overall survival rates were 95.38% and 73.56%, respectively, and median overall survival was 80 months. Univariate analysis revealed that pelvic lymph nodemetastasis, cervical stromal invasion, parametrial infiltration, tumor diameter reduction 〈3 cm and advanced stage were the prognostic factors in patients with cervical cancer （P〈0.05）. Age, postoperative radiochemotherapy, lymphatic clearance involvement, FIGO stage, preservation of ovary and pathologic type were not associated with prognosis （P〉0.05）. Multivariate Cox proportional analysis revealed that pelvic lymph node metastasis and tumor diameter reduction after radiation and chemotherapy were the independent prognostic factors in patients with cervical cancer. Conclusion： The combination of neoadjuvant chemotherapy and surgery improves the resectable rate of patients with I B2- II A2 uterine adenocarcinoma and adenosquamous carcinoma. Pelvic lymph node metastasis and tumor diameter reduction after radiation and chemotherapy are the indenendent prognostic factors in patients with cervical cancer.