新辅助化疗联合根治性子宫切除术治疗局部晚期宫颈癌的疗效及其影响因素

Efficacy and influencing factors of neoadjuvant chemotherapy combined with radical hysterectomy for treatment of locally advanced cervical cancer

目的探讨新辅助化疗联合根治性子宫切除术治疗局部晚期宫颈癌(LACC)的疗效及其影响因素。方法将100例LACC患者分为观察组(新辅助化疗+根治性子宫切除术)50例,对照组(根治性子宫切除术)50例,其中新辅助化疗采用紫杉醇+顺铂方案。比较两组患者生存时间和生存率,采用Cox比例风险回归模型分析影响观察组患者3年生存率的影响因素。结果观察组、对照组中位生存期分别为43个月和37个月,观察组1、2、3年生存率分别为98.0%、90.0%、80.0%,均明显优于对照组的92.0%、78.0%、68.0%(P<0.05);单因素分析显示年龄、病灶大小、组织分化、病理类型、淋巴结转移对观察组患者3年生存率有影响(P<0.05),Cox比例风险回归模型分析显示病灶大小、组织分化、病理类型、淋巴结转移是观察组患者3年生存率的独立影响因素(P<0.05)。结论新辅助化疗联合根治性子宫切除术治疗LACC可提高患者的生存率,病灶大小、组织分化、病理类型以及淋巴结转移是其重要的预后因素。

Objective To explore the efficacy and influencing factors of neoadjuvant chemotherapy（NACT） combined with radical hysterectomy for treating locally advanced cervical cancer（LACC）. Methods A hundred patients with LACC were divided into observation group treated with NACT combined with radical hysterectomy（ n = 50 ） and control group treated with radical hysterectomy（ n = 50）. Paclitaxel and cisplatin were included in the plan of NACT. The survival time and survival rate were compared between the two groups. The factors influencing 3-year survival rate of the patients in the observation was analyzed using Cox＇s proportional hazards regression model. Results The median survival times of the observation group and control group were 43 months and 37 months respectively. The 1- ,2- ,3-year survival rates of the observation group were significantly higher than those in the control group（98.0% vs. 92.0% ,90.0% vs. 78.0% and 80.0% vs. 68.0%, respectively ,P 〈0. 05 ）. Univariate analysis showed that age ,tumor size, histological differentiation, pathological type and lymphonode metastasis influenced the 3-year survival rate of the patients in the observation group （P 〈0.05）. Cox＇s proportional hazards regression model analysis showed that tumor size,histological differentiation,pathological type and lymphonode metastasis were the independent prognostic factors for the 3-year survival rate of the patients in the observation group（P 〈0. 05）. Conclusion For the patients with LACC, NACT combined with radical hysterectomy can increase the survival rate of the patients, and tumor size ,histological differentiation ,pathological type and lymphonode metastasis are its important prognostic factors.