两种介入方法联合根治术治疗宫颈癌的对比研究

目的比较子宫动脉化疗栓塞和髂内动脉灌注化疗联合根治术对宫颈癌的疗效。方法将1997年6月～2007年11月收治的81例宫颈癌患者分为2组。子宫动脉化疗栓塞组4l例,髂内动脉灌注化疗组40例。两组均为以卡铂为主的联合方案。两组患者介入治疗后2周行宫颈癌根治术。结果子宫动脉化疗栓塞组临床有效率为73.2%,高于髂内动脉灌注化疗组(40.0%,P=0.003)。动脉化疗栓塞组ⅠB期患者的临床有效率(86.7%)明显高于动脉灌注化疗组(28.6%,P=0.002)。子宫动脉化疗栓塞组病理完全缓解率、盆腔淋巴结转移阴性率均略高于髂内动脉灌注化疗组,脉管侵犯阴性率略低于髂内动脉灌注化疗组,但差异无统计学意义(P0.05);子宫动脉化疗栓塞组5年总生存率(94%)与髂内动脉灌注化疗组(83%)相比差异无统计学意义(P=0.429)。结论子宫动脉化疗栓塞在控制宫颈癌肿瘤大小方面优于髂内动脉灌注化疗,两种介入治疗方法联合根治术治疗宫颈癌的远期生存率无明显差异。

Comparison of two interventional therapies followed by radical hysterectomy for women with cervical cancer

Objective To evaluate the curative effects of uterine artery chemoembolization （UACE） and intemal iliac arterial infusion chemotherapy （IAIC） followed by radical hysterectomy for the treatment of cervical cancer and to determine the prognostic factors affecting survival. Methods Eighty-one patients with cervical cancer treated between June 1997 and November 2007 were retrospectively analyzed. Patients were divided into two groups： the UACE group （n=41） and the IAIC group （n--40）. The UACE group was treated by bilateral uterine artery chemoembolization. The IAIC group was treated by bilateral internal iliac arterial infusion chemotherapy. All patients were treated by carboplatin-based combination chemotherapy and underwent radical hysterectomy 2 weeks after 1-3 times of UACE or IAIC, Radiotherapy was performed on 24 requisite patients with high risk of pathological factors after radical surgery. Results The clinical response rate of the UACE group was 73.2%, significantly higher than that in the IAIC group （40.0%,P= 0.003）. The effective rate for clinical stage IB cervical cancer in the UACE group was 86.7%, significantly higher than 28.6% in the IAIC group （P = 0.002）. However for FIGO stage ]I cervical cancer, the effective rates between the two groups had no significant difference （P= 0.202）. Postoperative pathologic examinations showed the pathological complete response rate and the negative percentages of pelvic lymph node metastasis in the UACE group were slightly higher than those in the IAIC group （14.6% and 87.8% vs. 5.0% and 80.0%, P = 0.264 and P= 0.313）. The recurrent rate in the UACE group was lower than that in the IAIC group （9.8% vs. 22.5% ,P= 0.118）. The negative percentage of lymphovascular space invasion in the UACE group was slightly lower than that in the IAIC group （90.2% vs. 100.0%, P = 0.072）. The 5-year overall survival rates in the UACE group and the IAIC group were 94% and 83%, respectively （P = 0.429）. Univariate and multivariate analysis showed that pelvic lymph node metastasis and lymphovascular space invasion remained independent prognostic factor （P= 0.001, P= 0.028）. Conclusion UACE can effectively reduce the tumor volume of cervical cancer compared with IAIC, but failed to increase the pathological complete response rate and decrease the pelvic lymph node metastasis rate, the postoperative recurrence rate and lymphovascular space invasion. No significant difference exists between effect of UACE and IAIC on the long-term survival of cervical cancer.