新辅助化疗对194例局部晚期宫颈癌患者疗效观察及预后分析

The Effect of Neoadjuvant Chemotherapy in 194 Patients with Locally Advanced Cervical Cancer and Prognostic Analysis

目的:探讨新辅助化疗(Neoadjuvant chemotherapy, NACT)联合手术治疗对IB2和IIA2期局部晚期宫颈癌患者的疗效及生存预后情况。方法:收集2006年9月~2015年5月于青岛大学附属医院妇科接受治疗的IB2和IIA2期局部晚期宫颈癌患者,NACT联合手术治疗131例,直接手术(RH) 63例,观察新辅助化疗的近期疗效,并对两组患者术后生存情况进行对照分析。结果:宫颈鳞癌患者近期有效率74.55%,非鳞癌近期有效率33.33%,差异有统计学意义;低分化、中分化及高分化患者近期有效率分别为79.49%、62.5%、50%,差异有统计学意义。NACT组1年、3年、5年OS分别为98.5%、93.1%、87.6%,RH组患者1年、3年、5年OS分别为96.8%、85.5%、78.7%,两组5年OS差异有统计学意义(P = 0.036)。将NACT组患者再次分为近期有效者与无效者,两组患者5年OS分别为93%、77.3%,有统计学差异(P = 0.006);NACT有效者与无效者5年DFS分别为90.9%、76.9%,有统计学差异(P = 0.041)。结论:宫颈鳞癌患者及组织分化较低的患者对NACT更为敏感;NACT可以提高局部晚期宫颈癌患者的远期生存率;相对于NACT无效者,NACT有效者可延长LACC患者的总生存期和无瘤生存期。

Objective: To investigate the efficacy and survival prognosis of neoadjuvant chemotherapy (NACT) combined with surgical treatment for patients with stage IB2 and IIA2 locally advanced cervical cancer. Methods: Collect IB2 and IIA2 locally advanced cervical cancer patients treated in the Department of Gynecology, Qingdao University Affiliated Hospital from September 2006 to May 2015. 131 cases of NACT combined with surgery and 63 cases of direct surgery (RH) were collected. Neoadjuvant chemotherapy was observed. After the short-term curative effect, the survival situation of the two groups of patients was compared and analyzed. Results: The short-term effective rate for patients with cervical squamous cell carcinoma was 74.55%, and the short-term effective rate for non-squamous cell carcinoma was 33.33%. The difference was statistically significant. The short-term effective rates for poorly differentiated, moderately differentiated, and well-differentiated patients were 79.49%, 62.5%, and 50%, respectively. The difference was statistically significant. The 1-year, 3-year, and 5-year OS of the NACT group were 98.5%, 93.1%, and 87.6%, respectively. The 1-year, 3-year, and 5-year OS of the RH group were 96.8%, 85.5%, and 78.7%, respectively. The 5-year OS difference between the two groups was statistically significant (P = 0.036). The patients in the NACT group were divided into the effective and ineffective patients again. The 5-year OS of the two groups was 93% and 77.3% respectively, which was statistically different (P = 0.006);the 5-year DFS of the effective and ineffective NACT patients was 90.9% and 76.9%, respectively, there is a statistical difference (P = 0.041). Conclusion: Cervical squamous cell carcinoma patients and patients with low tissue differentiation are more sensitive to NACT;NACT can improve the long-term survival rate of locally advanced patients;compared with those who had no NACT, those who had NACT could prolong the total survival and tumor-free survival of LACC patients.