不同方式治疗局部晚期宫颈癌预后分析

Prognostic analysis of different treatments for locally advanced cervical cancer

目的探讨新辅助化疗联合手术(neoadjuvant chemotherapy and radical surgery,NACT+RS)与单纯手术(radical surgery,RS)对局部晚期宫颈癌预后的影响。方法收集2013年1月—2015年12月蚌埠医学院第一附属医院妇瘤科收治的119例局部晚期宫颈癌患者,依照治疗方式不同分为NACT+RS组74例,RS组45例,其中NACT+RS组根据化疗疗效分为有效组45例,无效组29例。比较NACT+RS组与RS组手术时间、术中出血量、术后病理特征及5年生存情况,比较NACT有效组与RS组术后病理特征及5年生存情况,评价NACT有效联合手术对患者生存的影响。结果NACT+RS组与RS组相比,术中出血量、手术时间、淋巴结转移、肌层浸润及5年生存率差异均无统计学意义(均P>0.05)。NACT+RS组术中出血量较RS组少,差异有统计学意义(P<0.05)。而NACT有效组与RS组淋巴结转移阳性率分别为4.4%、17.8%,差异有统计学意义(χ^(2)=4.050,P=0.044),深肌层浸润率分别为20.0%、55.6%,差异有统计学意义(χ^(2)=12.101,P=0.001)。NACT有效组5年生存率为93.3%,相对于RS组的73.3%,差异有统计学意义(χ^(2)=6.480,P=0.011)。结论相对于单纯手术,新辅助化疗有效联合手术降低了淋巴结转移及肌层浸润率并能明显改善患者远期预后。

Objective To investigate the effect of neoadjuvant chemotherapy and radical surgery(NACT+RS)and surgery alone(radical surgery,RS)on the prognosis of locally advanced cervical cancer.Methods From January 2013 to December 2015,119 patients with locally advanced cervical cancer were divided into the NACT+RS group(n=74)and the RS group(n=45).According to the curative effect of chemotherapy,the NACT+RS group was divided into an effective group(n=45)and an ineffective group(n=29).The operation time,intraoperative blood loss,post-operative pathological features and 5-year survival between the NACT+RS and RS groups were compared,and the post-operative pathological features and 5-year survival between the NACT effective group and the RS group were compared to evaluate the effect of NACT combined operation on patient survival.Results No significant difference in intraoperative blood loss,operation time,lymph node metastasis,myometrial invasion and 5-year survival rate was found between the NACT+RS and RS groups.The amount of intraoperative blood loss in NACT+RS group was significantly less than that in RS group(P<0.05).Compared with that in the NACT effective group,the positive rate of lymph node metastasis in the RS group was 4.4%and 17.8%,respectively,and the difference was statistically significant(χ^(2)=4.050,P=0.044).In addition,the deep muscle infiltration rate was 20.0%,55.6%,respectively,and the difference was statistically significant(χ^(2)=12.101,P=0.001).The 5-year survival rate of the NACT effective group was 93.3%,whereas that of the RS group was 73.3%(χ^(2)=6.480,P=0.011).Conclusion Compared with simple operation,neoadjuvant chemotherapy combined with surgery can reduce lymph node metastasis and myometrial invasion and improve the long-term prognosis of patients.