剂量密集型新辅助化疗治疗局部晚期宫颈癌的临床分析

A Study on the Clinical Efficacy of High-dose density Neoadjuvant Chemotherapy on Locally Advanced Cervical Cancer

目的比较剂量密集型新辅助化疗(10日疗法)与传统新辅助化疗(21日疗法)治疗宫颈癌的临床疗效。方法回顾性收集局部晚期宫颈癌进行新辅助化疗+手术患者的临床病理资料。剂量密集型组采用紫杉醇60mg/m2+顺铂60mg/m2静脉滴注,间隔10d。传统化疗组采用紫杉醇135mg/m2+顺铂70mg/m2静脉滴注,间隔21d。比较两组患者临床疗效的差异。结果所有患者在接受新辅助化疗后2周进行评估,剂量密集型组患者临床缓解率为78.6%、化疗后手术率为89.3%,与传统化疗组(75.0%及93.8%)比较,差异无统计学意义(P>0.05)。两组患者术后病检测量的肿瘤直径均较化疗前CT测量直径缩小[化疗前:剂量密集型组:(4.5±1.4)cm,传统化疗组:(4.6±1.3)cm;化疗后:剂量密集型组:(2.2±1.4)cm,传统化疗组:(2.3±1.5)cm]。术后病理结果显示,两组淋巴结阳性率、宫旁浸润率、脉管浸润率及深肌层浸润率比较,差异无统计学意义(P>0.05)。剂量密集型组患者术后放疗率及3年累积生存率分别为60.0%及76.0%,传统化疗组患者术后放疗率及3年累积生存率分别为55.6%及82.0%,差异无统计学意义(P>0.05)。两组化疗副反应发生率比较,差异无统计学意义(P>0.05)。结论剂量密集型新辅助化疗与传统新辅助化疗对宫颈癌患者的临床效果相似,且可缩短手术前化疗时间,是一种治疗宫颈癌的有效新辅助化疗方法。

Objective To compare the clinical efficacy of high-dose density neoadjuvant cnemomerapy （HDNC） and classic neoadjuvant chemotherapy （CNC） on locally advanced cervical carcinoma. Methods 76 patients with locally advanced cervical carcinoma were treated with operations and neoadjuvant chemotherapy between January of 2009 and December of 2015 in Sichuan Provincial People＇s Hospital and selected as research subjects in this study. The clinicopathological data were analyzed retrospectively. The patients were divided into the HDNC group, in which the patients received 2 cycles of intravenous drip of 60 mg/m2 cisplatin and 60 mg/m2 paclitaxel with 10-day intervals, and the CNC group, in which the patients received 2 cycles of intravenous drip of 70 mg/m2 cisplatin and 135 mg/m2 paclitaxel with 21-day intervals. The data were compared to analyze the differences of clinical efficacy between the two groups. Results After all the patients received neoadjuvant chemotherapy for 2 weeks, the clinical remission rate and the surgical rate of the HDNC group were 78. 6% and 89.3% respectively, while those of the CNC group were 75 % and 93.7%respectively, which showed no statistical significance between the two groups. The diameter of the tumors was reduced after neoadjuvant chemotherapy. The postoperative pathological results showed that there were no significant differences between the two groups in the positive rate of lymph node and the rate of the parametrial infiltration, the lymphovascular space invasion and the deep stromal invasion. The postoperative radiotherapy rate and the 3-year cumulative survival rate of the HDNC group were 60% and 76% respectively, while those of the CNC group were 55.6% and 82%, which showed no significant differences between the two groups. Conclusion The neoadjuvant chemotherapy with high-dose density of cisplatin and paclitaxel for the patients with locally advanced cervical carcinoma has the same clinical efficacy as the classic neoadjuvant chemotherapy, but it can shorten the chemotherapy time before operation. Therefore, it is an effective neoadjuvant chemotherapy for locally advanced cervical carcinoma.