新辅助化疗对宫颈癌手术患者的近远期疗效观察

Effect of neoadjuvant chemotherapy on postoperative short-and long-efficacy in patients with cervical cancer

目的探讨新辅助化疗对宫颈癌术后患者近远期疗效的影响。方法选取2010年12月至2016年3月间在四川省达州市中心医院行广泛全子宫切除+盆腔淋巴结清扫术的100例Ⅰb~Ⅱa2期巨块型宫颈癌(直径≥4cm)患者临床资料,根据治疗方法不同分成观察组与对照组,观察组44例患者,术前采用新辅助化疗,对照组56例患者,单纯手术治疗。比较两组患者化疗前和化疗后48h、7d及14d等时间点临床症状改善效果、肿瘤最大横断直径、组织学有效率及宫颈癌病理组织中p16蛋白表达动态变化情况,并比较两组近远期疗效差异。结果观察组化疗后7d和化疗后14d临床症状总改善率为65.9%和79.5%,组织学有效率为68.2%和88.6%均较化疗后48h明显提升,差异有统计学意义(P<0.05),且患者除化疗后48h肿瘤最大横断直径、p16蛋白表达阳性率同化疗前比较,差异均无统计学意义(均P>0.05)外,化疗后7d、14d等时间点肿瘤最大横断直径[(4.5±0.8)cm、(4.1±0.6)cm]及病理组织中p16蛋白表达阳性率(86.4%、72.7%)均显著低于化疗前的(5.4±1.3)cm和100.0%,差异均有统计学意义(P<0.05)。观察组术中出血量显著低于对照组[(355.6±159.2)ml vs(583.5±200.6)ml,P<0.05];但两组受试者手术成功率和术后并发症发生率对比差异无统计学意义(P>0.05)。观察组三年复发率显著低于对照组(15.9%vs 35.7%),且5年生存率显著高于对照组(65.9%vs 42.9%),差异均有统计学意义(P<0.05)。结论将以顺铂为基础的新辅助化疗应用于行广泛全子宫切除+盆腔淋巴结清扫术的Ⅰb~Ⅱa2期巨块型宫颈癌患者临床治疗中,利于病情恢复,近远期疗效均较为理想。

Objective To investigate the effect of neoadjuvant chemotherapy （NACT） on postoper- ative short- and long-efficacy in patients with cervical cancer. Methods The clinical data of 100 patients with stage Ib - IIa2 bulky cervical cancer （diameter ≥4 cm） who underwent extensive total hysterectomy and pelvic lymph node dissection from December 2010 to March 2016 were analyzed retrospectively. Ac- cording to the treatment regimen, patients were divided into an observation group and a control group. Forty- four patients in the observation group were given preoperative neoadjuvant chemotherapy and 56 patients in the control group received single surgery. The relief of clinical symptoms, the maximum cross-sectional di- ameter of tumors, efficacy rate according to the histological test and changes in the expression of p16 protein in pathological tissues were compared before chemotherapy, at 48 h, 7 d and 14 d after the chemotherapy. The differences in short and long-term treatment efficacy were analyzed between the two groups. Results At 7 d and 14 d after chemotherapy, the overall relief rate of clinical symptoms （65.9% and 79. 5% , re- spectively） and efficacy rate according to the histological test （68.2% and 88.6% ） in the observation group were significantly higher than at 48 h after chemotherapy （P 〈0.05）. At 7 d and 14 d after chemo- therapy, the maximum cross-sectional diameter of tumors [ （4. 5 ±0. 8） cm and （4. 1 ±0. 6） cm]and posi- tive expression rate of p16 protein in pathological tissues （ 86.4% and 72. 7% ） were significantly lower than [ （5.4 ± 1.3） cm, 100. 0% ] of before chemotherapy （P 〈 0.05 ）, although at 48 h after chemothera- py, no significant difference was found in the maximum cross-sectional diameter of tumors, positive expres- sion rate of p16 protein before and after chemotherapy （P 〉 0. 05）. The intraoperative bleeding volume was significantly lower in the observation group than in the control group [ （355.6 ± 159. 2） ml vs （583.5 ± 200. 6） ml, P 〈0. 05]. However, There was no significant difference in the success rate of operation and the incidence of postoperative complications between the two groups （P 〉 0.05 ）. The 3-year recurrence rate was significantly lower in the observation group than in the control group （ 15.9% vs 35.7% ）, while the 5- year survival rate was significantly higher than in the control group （65.9% vs 42. 9% ） （P 〈 0.05 ）. Con- elusion Cisplatin based NACT can promote the outcome in patients with stage Ib ~ IIa2 bulky cervical cancer undergoing extensive total hysterectomy and pelvic lymph node dissection, and the short and long- term therapeutic effects are ideal, which is good for the recovery of prognosis.