文章摘要

不同新辅助治疗方法联合手术治疗Ib2/IIa2期 子宫颈鳞癌的效果分析

作者: 1李 宁, 1姚 洪文, 1张 蓉, 1李 斌, 1李 晓光, 1马 绍康, 1吴 令英
1 国家癌症中心/中国医学科学院,北京协和医学院肿瘤医院妇瘤科,北京 100021
通讯: 吴 令英 Email: wulingying@csco.org.cn
DOI: 10.3978/j.issn.2095-6959.2017.12.014
基金: 中国医学科学院肿瘤医院科研课题(LC2012B38)。

摘要

目的:比较根治术前采用单纯新辅助化疗、新辅助腔内放疗及二者联合用于治疗Ib2/IIa2期子宫颈鳞癌对患者手术、术后辅助治疗方式及预后的影响。方法:对中国医学院肿瘤医院2001年1月至2013年12月接受术前新辅助治疗联合根治性手术的Ib2/IIa2期宫颈鳞癌患者324例进行回顾性分析。根据术前3种新辅助治疗方法分为3组:单纯化疗组(neoadjuvant chemotherapy alone,NAC)、单纯腔内放疗组(B)和化疗联合腔内放疗组(NAC+B)。比较各组新辅助治疗的有效率(完全缓解+部分缓解)、术后危险因素的比例、术后辅助治疗情况及复发生存情况。采用SPSS 24.0软件进行统计分析,各组间率的比较采用卡方检验,复发及生存率的比较采用log-rank分析。结果:NAC组109例,B组90例,NAC+B组125例。中位随访时间57个月。3组发病年龄、分化程度、宫颈肿瘤生长类型差异均无统计学意义。B组无脱发、无3~4度的骨髓及消化道不良反应发生。NAC组和NAC+B组的3~4度中性粒细胞减少症及消化道反应的发生率相当。3组之间术中输血比例、输尿管损伤的发生率差异没有统计学意义(P>0.05)。NAC组、B组和NAC+B组的治疗有效率分别为55.0%,48.8%和60.0%(P=0.270);三组术后危险因素的比例:宫旁受侵0.9%,1.1%和1.6%;切缘阳性1.8%,1.1%和0%;淋巴结转移22.0%,28.9%和21.6%;淋巴脉管间隙受侵16.5%,12.2%和12.8%;深间质受侵:58.7%,55.6%和51.2%,3组间差异均没有统计学意义(P>0.05)。3组间术后接受放疗或放化疗的比例分别为57.8%,62.2%和52.0%(P=0.317)。全组5年无复发生存率(DFS)和5年生存率(OS)分别为87.0%和91.0%。3组5年DFS分别为92.0%,80.0%和86.4%(P=0.056),5年OS分别为94.0%,85.6%和92.0%(P=0.097)。结论:3种新辅助治疗方法联合根治性手术治疗Ib2/IIa2期宫颈癌可获得较好的效果,3组间的5年生存率无明显差别。化疗联合腔内放疗与单一新辅助治疗相比,不能降低术后辅助放疗的比例。
关键词: 宫颈癌;化疗;手术;新辅助化疗;近距离放疗

Effects of neoadjuvant therapies combined surgery on stage Ib2/IIa2 cervical squamous cell carcinoma

Authors: 1LI Ning, 1YAO Hongwen, 1ZHANG Rong, 1LI Bin, 1LI Xiaoguang, 1MA Shaokang, 1WU Lingying
1 Department of Gynecologic Oncology, National Cancer Center/Chinese Academy of Medical Sciences, Cancer Hospital of Peking Union Medical College, Beijing 100021, China

CorrespondingAuthor:WU Lingying Email: wulingying@csco.org.cn

Foundation: This work was supported by the Clinical Research of Cancer Hospital, Chinese Academy of Medical Sciences

Abstract

Objective: To compare the clinical efficacy and safety of neoadjuvant chemotherapy alone, neoadjuvant brachytherapy alone and combination of the two methods followed by radical surgery in patients with stage Ib2/IIa2 cervical squamous cell carcinoma. Methods: Between Jan, 2001 and Dec, 2013, 324 patients with stage Ib2/IIa2 cervical squamous cell carcinoma received neoadjuvant therapy followed by radical hysterectomy and pelvic lymph node dissection +/− para-aortic lymph node dissection in Cancer Hospital, Chinese Academy of Medical Sciences. The patients were divided into 3 groups according to the methods of neoadjuvant therapy, neoadjuvant chemotherapy alone (NAC), neoadjuvant brachytherapy alone (B) and combination of the two methods (NAC+B). Response rate (complete response + partial response), postoperative risk factors, postoperative adjuvant therapy, and survival were respectively compared among 3 groups. SPSS 24.0 was used for statistical analysis. Results: The patient number of groups NAC, B and NAC+B was 109, 90 and 125, respectively. The median follow up time was 57 months. There were no statistic difference regarding age, tumor grade and growth type of cervical tumor among 3 groups (P>0.05). No alopecia and grade 3/4 blood toxities was reported in group B. The frequency of grade 3/4 neutropenia and gastric-intestine adverse events was comparable between group NAC and NAC+B. There was no statistic difference of blood loss, surgery time and urinary injury among 3 groups. Response rates of NAC, B and NAC+B group were 55.0%, 48.8% and 60.0%, respectively (P=0.270). The percentage of postoperative risk factors in NAC, B and NAC+B group were as follows: parametria invasion 0.9%, 1.1% and 1.6%; positive margin 1.8%, 1.1% and 0%; lymph node metastasis 22.0%, 28.9% and 21.6%; lymph vascular space invasion (LVSI) 16.5%, 12.2% and 12.8%; deep stromal invasion (DSI) 58.7%, 55.6% and 51.2%, respectively (P>0.05). Among the groups of NAC, B and NAC+B, the percentage of postoperative radiation +/− chemotherapy were 57.8%, 62.2% and 52.0% (P=0.317). The overall 5-year disease-free survival (DFS) and overall survival rates (OS) were 87.0% and 91.0%, respectively. Five-year DFS of these 3 groups were 92.0%, 80.0% and 86.4%, respectively (P=0.056). Five-year OS of the 3 groups were 94.0%, 85.6% and 92.0%, respectively (P=0.097). Conclusion: Patients with stage Ib2/IIa2 cervical squamous cell carcinoma received neoadjuvant therapy followed by radical surgery +/− postoperative radiation had good prognosis. There were no statistically significant differences of peri-operation complications, postoperative risk factors, DFS and OS among NAC, B and NAC+B groups.
Keywords: cervical cancer; chemotherapy; surgery; neoadjuvant therapy; brachytherapy