局部晚期宫颈癌同步放化疗后的手术探讨

Surgical treatment of locally advanced cervical cancer after concurrent chemoradiotherapy

目的探讨局部晚期宫颈癌同步放化疗后的手术范围及临床疗效。方法回顾性分析2013-01~2016-12收治的444例ⅠB2-ⅡB期宫颈癌患者临床资料,根据术前是否接受同步放化疗分为两组:术前接受同步放化疗264例为术前同步放化疗(CCRT)+手术组,术前未接受任何治疗180例为手术组。分析比较两组患者的手术时间、术中出血量、术后住院天数、术中术后并发症、术后病理资料和术后补充放化疗及复发生存等情况。统计分析CCRT+手术组术前同步放化疗的临床疗效。结果两组患者在年龄、BMI和病理类型方面,差异无统计学意义(P>0.05)。两组的手术时间、术中出血量、术后住院时间、术后通气时间和术后尿管留置时间均无明显差异(P<0.05)。术前接受同步放化疗的总有效率(CR+PR)为92.6%,其中CR 9.1%,PR 87.1%。宫颈深间质浸润阳性率,淋巴结转移阳性率、淋巴脉管浸润阳性率,手术组均高于CCRT+手术组,差异均有统计学意义(P<0.05)。CCRT+手术组和手术组术后接受辅助治疗的患者分别为24例和162例,差异有统计学意义(P<0.05)。手术组患者术后辅助放疗后下肢水肿、放射性肠炎、放射性膀胱炎的发生率高于CCRT+手术组,差异均有统计学意义(P<0.05)。CCRT+手术组和手术组患者3年无进展生存率分别为91.7%和90.0%,3年总生存率分别为93.6%和92.8%,差异均无统计学意义(P>0.05)。结论局部晚期宫颈癌采用术前同步放化疗联合根治性手术的综合治疗方法可以取得较好的临床疗效,不增加术中及术后并发症的发生率。

Objective To explore the surgical scope and clinical efficacy of locally advanced cervical cancer（ LACC） after concurrent chemoradiotherapy（ CCRT）. Methods The clinical data of 444 LACC patients with stage ⅠB2-Ⅱ B receiving robot-assisted radical surgery from January 2013 to December 2016 were retrospectively analyzed. These patients were divided into two groups according to the treatment of preoperative CCRT. Totally 264 patients with preoperative CCRT were in CCRT ＋ radical surgery group,while 180 patients without receiving any adjuvant therapy before operation were in radical surgery group. The operative time,intraoperative blood loss,postoperative hospital stay,intraoperative and postoperative complications,postoperative pathological data,postoperative adjuvant radiotherapy and chemotherapy,and recurrence were analyzed. The clinical efficacy of preoperative concurrent chemoradiotherapy in CCRT ＋ radical surgery group was analyzed statistically. Results There was no significant difference in age,BMI and pathological type between the two groups（ P〈0. 05）. There was no significant difference in operation time,intraoperative blood loss,postoperative hospital stay,postoperative ventilation time and postoperative catheter indwelling time between the two groups（ P〈0. 05）. The total effective rate of preoperative CCRT（ CR ＋ PR） was 92. 6%,including 9. 1% for CR and 87. 1% for PR. The positive rates of deep cervical stromal invasion,lymph node metastasis and lymphatic vessel invasion were higher in radical surgery group than those in CCRT ＋radical surgery group（ P〈0. 05）. Totally 24 patients received adjuvant therapy in the CCRT ＋ radical surgery group and 162 patients in radical surgery group,and there was statistically significant difference（ P〈0. 05）. The incidence of leg edema,radiation enteritis and radioactive cystitis was significantly higher in radical surgery group than that in CCRT ＋ radical surgery group（ P〈0. 05）. The 3-year progression-free survival rate was 91. 7% in CCRT ＋ radical surgery group and 90. 0% in radical surgery group,and there was no significant difference between the two groups（ P〈0. 05）. The 3-year overall survival rates were 93. 6% and 92. 8% in CCRT ＋ radical surgery group and radical surgery group,respectively,and there was no significant difference between the two groups（ P〈0. 05）.Conclusion The preoperative CCRT combined with radical surgery for LACC can achieve better clinical curative effect but not increase in the incidence of intraoperative and postoperative complications.