宫颈鳞状细胞癌ⅠB2期治疗模式探讨

目的 探讨宫颈鳞状细胞癌ⅠB2治疗方法及预后因素.方法 1999年5月至2010年5月,在中国医学科学院肿瘤医院初治、资料完整的宫颈鳞状细胞癌ⅠB2 264例入组.中位年龄43岁(21～60岁),全组中直接手术57例,术前新辅助化疗或新辅助化疗加腔内放疗140例,术前腔内放疗53例,放疗加增敏化疗14例.全组接受手术252例,其中2例因术中病理证实淋巴结转移而仅行淋巴结清扫,后改根治性放疗加化疗,250例行盆腔或加腹主动脉旁淋巴结清扫+Ⅲ型根治性子宫切除.结果 252例淋巴结清扫患者中切除淋巴结<20个47例,≥20个205例,淋巴结无转移190例,有转移62例.250例根治性子宫切除患者中,浅肌层受侵117例,深肌层受侵120例,未注明深度13例.脉管瘤栓阴性206例,阳性44例.高分化21例,中分化127例,低分化105例,未报分化11例.全组患者5年无瘤存活率、总存活率分别为85%、89%.术前化疗、放疗加手术,手术,同步放化疗三组无瘤存活率分别为85.2%、92.9%、52.2%,三组相比差异有统计学意义(P=0.001).淋巴结切除个数<20个与≥20个相比,无瘤存活率分别为77.9%、87.8%,差异临近统计学意义(P=0.057).淋巴结无转移与转移相比有统计学差异,P=0.001.脉管瘤栓阴性与阳性相比差异有显著性(P=0.000).而肌层受侵深度、组织分化程度对预后无影响.直接手术与术前新辅助化疗、放疗相比:淋巴结转移率直接手术组(31.6%)高于术前化疗、放疗组(21.8%),但无统计学差异.脉管瘤栓阳性率直接手术组(35.1%)明显高于术前化疗、放疗组(12.4%),差异有统计学意义(P=0.00).手术组接受术后辅助性放疗合并增敏化疗占71.9%,高于术前化疗、放疗组(62.2%),但无统计学差异.宫颈鳞状细胞癌ⅠB2期5年无瘤存活率、总存活率较高,达85%、89%.结论 术前化疗、放疗加手术和直接手术患者无瘤存活率好于同步放化疗.淋巴结转移数、脉管瘤栓明显影响预后.

Cervical squamous cell carcinoma for figo sageⅠ B2：treatment patterns discussing

Objective To investigate the treatment methods and prognostic factors of patient with cervical squarnous cell carcinoma for FIGO stage I B2. Methods A total of 264 patients who were initial-treated and with intact-date in Cancer Hospital, Chinese Academy of Medical Sciences from May 1999 to May 2010 were retrospectively analyzed. The median age was 43 years（ range from 21 to 60）. 57 patients initially treated with surgery （ group Ⅰ ）, 193 patients underwent preoperative neoadjuvant chemotherapy （ NACT ） and （or） brachytherapy （ group Ⅱ ）and 14 patients treated with concurrent ehemoradiation （CCRT） （group IM ）. Among the patients underwent operation,250 eases received type Ⅲ radical hysterectomy and pelvic lymphadenectomy and （or）para-aortic lymph node sampling. While 2 eases underwent pelvic lymphadeneetomy as intraoperative lymph nodes were eonfirmed metastasis pathlogieally, and changed to radical radiotherapy and concurrent chemotherapy. Results The 5-years disease-free survival and overall survival rates were 85%, 89% respectively. There were statistically significant difference in disease-free survival between group Ⅰ , Ⅱ, Ⅲ （ P = 0. 001 ）, which were 92. 9%, 85.2% , 52. 2% , respectively. Among the patients underwent surgery, the univariate analysis demonstrated that the number of lymph node dissection, number of metastatic lymph nodes and lymphovascular space invasion （LVSI） were significantly related to disease-free survival,while the depth of stromal invasion and grade of histological differentiation were not affect the prognosis. The positive ratio for LVSI in group Ⅰ （35.1%）was higher than groupⅡ （12. 4% ）, the difference had statistical significance（P = 0. 000）, but the lymph node metastasis rate and the stromal invasion hadno significant difference. In group Ⅰ ,71.9% patients（41/57）received adjuvant radiation combined with sensitive chemotherapy;In group Ⅱ, The rate was 62. 2% （ 120/193 ）, which were lower than group I, but there was no significant difference. The group Ⅱ was classified into three groups： NACT, NACT plus brachytherapy and brachytherapy. In the subgroup analysis, there were no significant difference in lymph node metastasis, deep stromal invasion and positive ratio for LVSI between three groups. Conclusions The 5-years disease-free survival and overall survival rate for cervical squamous carcinoma of stage I B2 were up to 85% and 89%. The disease-free survival for patients who were treated with preoperative chemotherapy and （or）radiotherapy plus radical surgery and direct operation,were better than patients received CCRT. The number of nodal metastases and LVSI affect the prognosis significantly.