新辅助化疗在局部晚期宫颈癌患者中的疗效观察

Effect of neoadjuvant chemotherapy in patients with locally advanced cervical cancer

目的探讨新辅助化疗在局部晚期宫颈癌患者中的疗效。方法根据术前是否接受新辅助化疗将108例局部晚期宫颈癌患者分为对照组(n=53)和观察组(n=55),对照组患者不给予新辅助化疗而直接进行开腹根治性手术治疗,观察组患者术前给予新辅助化疗。比较两组患者一般手术指标、血清肿瘤标志物[血管内皮生长因子(VEGF)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平、病理学结果、生命质量和观察组不良反应发生情况。结果观察组患者手术时间明显短于对照组(P﹤0.01),术中出血量明显低于对照组(P﹤0.01)。术后,两组患者血清VEGF、CEA、SCC-Ag水平均低于本组术前(P﹤0.05),且观察组患者血清VEGF、CEA、SCC-Ag水平均低于对照组(P﹤0.05)。观察组患者淋巴结转移阳性率、阴道切缘阳性率和宫旁累及阳性率均明显低于对照组(P﹤0.01)。术后,两组患者欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评分均高于本组术前(P﹤0.05),且观察组患者EORTC QLQ-C30评分高于对照组(P﹤0.05)。观察组新辅助化疗过程中发生胃肠道反应9例、轻度骨髓抑制1例、皮疹2例,不良反应总发生率为21.82%(12/55),对症治疗后均好转,未影响正常手术时间。结论术前进行新辅助化疗有助于缩短手术时间,减少术中出血量,降低血清肿瘤标志物水平,有效控制肿瘤转移,提高术后生活质量。

Objective To explore the effect of neoadjuvant chemotherapy in patients with locally advanced cervical cancer.Method According to whether or not they received neoadjuvant chemotherapy before surgery,108 patients with locally advanced cervical cancer were divided into control group(n=53)and observation group(n=55).Patients in the control group were treated with open radical surgery without neoadjuvant chemotherapy,and patients in the observation group were given neoadjuvant chemotherapy before surgery.The general surgical indicators,serum tumor marker[vascular endothelial growth factor(VEGF),carcinoembryonic antigen(CEA),squamous cell carcinoma antigen(SCC-Ag)]levels,pathological results,quality of life and the occurrence of adverse reactions in the observation group were compared between the two groups.Result The operation time of the observation group was significantly shorter than that of the control group(P<0.01),and the intraoperative blood loss was significantly lower than that of the control group(P<0.01).After operation,the serum VEGF,CEA,and SCC-Ag levels of the two groups of patients were lower than those before the operation(P<0.05),and the serum VEGF,CEA,and SCC-Ag levels of the observation group were lower than those of the control group(P<0.05).The positive rate of lymph node metastasis,the positive rate of vaginal resection margin and the positive rate of parauterine involvement in the observation group were significantly lower than those in the control group(P<0.01).After the operation,the scores of the European Organization for Research and Treatment of Cancer quality of life questionnaire 30(EORTC QLQ-C30)were higher than those of the preoperative group(P<0.05),and the EORTC QLQ-C30 scores of the observation group were higher than those of the control group(P<0.05).In the observation group,9 cases of gastrointestinal reactions,1 case of mild bone marrow suppression,and 2 cases of skin rash occurred in the observation group during neoadjuvant chemotherapy,the total incidence of adverse reactions was 21.82%(12/55),all cases improved after symptomatic treatment and did not affect normal operation time.Conclusion Preoperative neoadjuvant chemotherapy in patients with locally advanced cervical cancer is beneficial to reduce operation time and blood loss,reduce serum levels of tumor markers,effectively control parathyroid and lymphatic metastasis,and improve the quality of life of patients.