新辅助化疗手术与单纯手术治疗ⅠB2期、ⅡA2期宫颈癌患者的近期效果及远期生存率评价

Evaluation of short-term effect and long-term survival rate of neoadjuvant chemotherapy and simple surgery in patients with ⅠB2 and ⅡA2 cervical cancer

目的探讨对ⅠB2期、ⅡA2期宫颈癌患者实施新辅助化疗手术与单纯手术对近期效果及远期生存率的影响。方法回顾性分析我院2007年1月～2013年5月收治的192例ⅠB2期、ⅡA2期宫颈癌患者的临床资料,其中102例实施新辅助化疗手术治疗,记为A组;余90例单纯实施手术治疗,记为B组。对比两组术中出血量、手术耗时、术后住院时间,术后阴道切缘阳性率、脉管浸润率、宫颈间质浸润深度,术后1、3、5年复发率和生存率。结果A组术中出血量少于B组,手术耗时和术后住院时间均短于B组,差异均有统计学意义(P<0.05);A组术后阴道切缘阳性率、脉管浸润率和宫颈间质浸润深度与B组比较,差异无统计学意义(P>0.05);A组术后1年复发率和生存率与B组比较,无统计学差异(P>0.05),A组术后3年和术后5年的复发率均低于B组,生存率均高于B组,差异均有统计学意义(P<0.05)。结论新辅助化疗手术治疗ⅠB2期、ⅡA2期宫颈癌患者能够减少术中出血和手术耗时,加快术后恢复,虽然与单纯手术治疗患者的阴道切缘阳性率、脉管浸润率、宫颈间质浸润深度、术后1年复发率和生存率均相近,但是前者能够降低术后3年和5年复发率,提高生存率。

Objective To investigate the influence of neoadjuvant chemotherapy and surgery alone on the short-term effect and long-term survival rates of patients with Ⅰ B2 and Ⅱ A2 cervical cancer. Methods The clinical data of 192 patients with Ⅰ B2 and Ⅱ A2 cervical cancer admitted in the hospital from January 2007 to May 2013 were retrospectively analyzed. Among them, 102 patients underwent neoadjuvant chemotherapy, which was recorded as group A. The remaining 90 cases undergoing surgical treatment alone were recorded as group B. The intraoperative blood loss, opera- tion time, postoperative hospital stay, postoperative vaginal margin positive rate, vascular infiltration rate, depth of cervical interstitial infiltration, recurrence rate and survival rate at 1 year, 3 years and 5 years after surgery between two groups were compared. Results The amount of intraoperative blood loss in group A was lower than that in group B. The time of surgery and postoperative hospital stay in the group A were shorter than those of group B. And the difference was statistically significant（P〈0.05）. There was no significant difference in postoperative vaginal margin positive rate, vas- cular infiltration rate and depth of cervical interstitial infiltration between group A and group B（P〉0.05）. There was no significant difference in the recurrence rate and survival rate at 1 year after surgery between group A and group B（P〉 0.05）. The recurrence rates of the 3 years and 5 years after operation in the group A were lower than those of the group B, and the survival rate in the group A was higher than that of the group B, and the difference was statistically significant（P〈0.05）. Conclusion Neoadjuvant chemotherapy in patients with Ⅰ B2 and Ⅱ A2 cervical cancer can reduce intra- operative bleeding and surgery time-consuming, and accelerate postoperative recovery, although the positive rate of vaginal margin, vascular infiltration rate, and depth of cervical interstitial infiltration, the recurrence rate and survival rate at 1 year after surgery of the neoadjuvant chemotherapy are similar to those treated with surgery alone. But the former can reduce the recurrence rate at 3 and 5 years after surgery and improve the survival rate.