术前新辅助化疗对宫颈癌组织病理学动态变化及近远期疗效观察

Observation of the Effect of Preoperative Neoadjuvant Chemotherapy on Histopathological Dynamic Changes and the Short-term and Long-term Efficacy of Cervical Cancer

目的探讨术前新辅助化疗(NACT)对宫颈癌组织病理学及近远期疗效的影响。方法将择期手术的Ⅰb期~Ⅱa2期宫颈鳞状细胞癌患者67例作为研究对象,均经临床病理确诊,根据治疗方法分为对照组(32例)和NACT组(35例)。对照组直接行手术治疗,NACT组术前给予以铂类为基础的NACT,末次化疗结束后2~3周行手术治疗。评估2组疗效,病理组织学Ⅱ+Ⅲ级为有效组,0+Ⅰ级为无效组;检测NACT有效组、无效组及对照组术前鳞状细胞癌相关抗原(SCC-Ag)、细胞角蛋白19片段抗原21-1(CYFRA21-1)水平,记录淋巴结转移率、宫旁浸润率及病理组织学变化。随访至2015年5月,记录2组复发率和死亡率。结果 NACT影像学疗效有效率71.43%(25/35),病理组织学有效率60.00%(21/35)。NACT后肿瘤细胞坏死、变形,血管组织和纤维组织增多代替肿瘤组织。NACT有效组SCCAg、CYFRA21-1均下降,同组治疗前后有差异,且低于NACT无效组和对照组(P<0.05);NACT无效组化疗前后和对照组上述指标无差异。NACT组和对照组宫颈深肌层浸润率、术后复发率和1年生存率比较无差异,NACT组盆腔淋巴结阳性率为11.43%,低于对照组37.50%(P<0.05);NACT有效组术后复发率为0%,低于无效组21.42%(P<0.05)。结论术前NACT有助于降低宫颈癌肿瘤标志物水平,促使病理组织学发生改变,可为临床评估疗效提供客观资料。

Objective To explore the effect of preoperative neoadjuvant chemotherapy（NACT） on histopathological dy- namic changes and the short-term and long-term efficacy of cervical cancer. Methods 67 patients with stage I b- II a2 cervical squamous cell carcinoma who received elective operation were selected as the study subjects, and all were confirmed by clinical pathology. The subjects were divided into the control group（ 32 cases） and NACT group（35 cases） according to therapeutic meth- ods. The control group was treated by operation directly, while NACT group was treated by platinum-based NACT and 2 to 3 weeks after the end of chemotherapy,treated by operation. Efficacy of the 2 groups was evaluated. Histopathological 1I ＋ m grade were effective group, and 0 ＋ I grade was ineffective group;The levels of squamous cell carcinoma related antigen （SCC-Ag） and cy- tokeratin 19 fragment antigen 21-1 （ CYFRA21-1 ） level in NACT effective group, ineffective group and the control group were test- ed. The lymph node metastasis rate, parametrial infiltration rate and histopathological changes were recorded ; All patients were fol- lowed up to May 2015, and the recurrence rate and mortality rate were recorded. Results Effective rate of NACT imaging was 71.43% （25/35） while of pathologic histology was 60.00% （21/35）. After NACT,tumor cell necrosis and deformation,vascular tissue and fibrous tissue increase replaced tumor tissue. SCC-Ag and CYFRA21-1 in NACT effective group were decreased after chemotherapy, and they were lower than those in ineffective group and the control group after NACT （ P 〈 0.05 ） ; There was no sig- nificant difference in above indexes between the ineffective group and the control group before and after the chemotherapy. Cervi- cal deep muscularis infiltration rate, postoperative recurrence rate and 1-year survival rate showed no significant differences be- tween NACT group and the control group. The positive rate of pelvic lymph node in NACT group（ 11.43% ） was lower than that the control group （37.50%） （P 〈 0.05 ） ;The postoperative recurrence rate in NACT effective group（0% ） was lower than that in ineffective group（21.42% ） （P 〈 0.05 ）. Conclusion Preoperative NACT can reduce the levels of tumor markers of cervical cancer, and promote changes of pathologic histology, providing objective information for clinical evaluation.