局部晚期宫颈癌(ⅠB2及ⅡA2期)不同治疗模式的对比研究

Comparison of different treatment patterns of locally advanced cervical carcinoma(FIGO StageⅠB2,ⅡA2)

目的探讨局部晚期宫颈癌(ⅠB2及ⅡA2期)不同治疗模式的毒性反应及预后。方法2014年1月至2017年12月汕头大学医学院附属肿瘤医院收治的169例ⅠB2及ⅡA2期宫颈癌患者入组,其中同期放化疗组(A组)49例,根治性手术组(B组)58例,新辅助化疗+根治性手术组(C组)62例,分析其临床资料、毒副反应及近期疗效。结果A组、B组、C组胃肠道反应发生率(95.9%vs 75.9%vs 98.4%,P<0.001)、骨髓抑制发生率(71.4%vs 56.9%vs 77.4%,P=0.011)差异均有统计学意义;肝功能损害发生率(8.2%vs 8.6%vs 14.5%,P=0.462)、肾功能损害发生率(4.1%vs 0.0%vs 1.6%,P=0.279)差异均无统计学意义。3~4度胃肠道反应发生率(8.2%vs 6.9%vs 8.1%,P=0.961)、3-4度骨髓抑制发生率(32.7%vs 19.0%vs 14.5%,P=0.059)、3~4度肝功能损害发生率(2.0%vs 0%vs 3.2%,P=0.403)差异均无统计学意义;三组均未出现3~4度肾功能损害。A组、B组、C组2年无复发生存率分别为77.3%、87.0%、87.2%,差异均无统计学意义(P=0.343)。结论局部晚期宫颈癌三种治疗模式严重的毒副反应发生率及近期疗效无明显差异,应根据患者的年龄、体质、对阴道功能及卵巢功能保留的意愿等情况综合考虑,选择合适的治疗模式。

Objective To evaluate the toxicity and prognosis of different treatment patterns of locally advanced cervical carcinoma(FIGO StageⅠB2,ⅡA2).Methods 169 cases with locally advanced cervical carcinoma(FIGO Stage Ib2,IIa2)treated in Cancer Hospital of Shantou University Medical College from Jan.2014 to Dec.2017 were enrolled.49 patients underwent concurrent chemoradiotherapy(Group A),58 patients underwent radical hysterectomy plus pelvic lymphadenectomy(Group B),and 62 patients underwent neoadjuvant chemotherapy followed with radical hysterectomy plus pelvic lymphadenectomy(Group C).The clinical data,side effects and follow-up data were analyzed.Results The differences of rates of gastrointestinal reactions(95.9%vs 75.9%vs 98.4%,P<0.001)and bone marrow suppression(71.4%vs 56.9%vs 77.4%,P=0.011)among Group A,Group B and Group C were significant.There were no significant differences of hepatic functions damage rates(8.2%vs 8.6%vs 14.5%,P=0.462)and renal functions damage rates(4.1%vs 0.0%vs 1.6%,P=0.279)among three groups.The differences ofⅢ~Ⅳdegree of gastrointestinal reactions rates(8.2%vs 6.9%vs 8.1%,P=0.961)、bone marrow suppression rates(32.7%vs 19.0%vs 14.5%,P=0.059)and hepatic functions damage rates(2.0%vs 0%vs 3.2%,P=0.403)among three groups were not significant,and theⅢ~Ⅳdegree of renal functions damage rates were not found in any groups.The 2-year rates of recurrence-free survival of three groups were 77.3%、87.0%、87.2%,respectively,the difference was not significant(P=0.343).Conclusions The rates of severe toxic side effects and prognosis of three treatment patterns of locally advanced cervical carcinoma were similar.Appropriate treatment patterns should be performed to the patients with locally advanced cervical carcinoma according to the patients’age,physical status,the desires for the functions of the vagina and ovary.