新辅助化疗在宫颈癌治疗中的应用研究

目的 分析新辅助化疗在宫颈癌治疗中的临床应用.方法 回顾性分析湖北省武汉市都市妇产医院自2013年3月至2015年3月收治的IB2~IIB期的宫颈癌根治术前静脉化疗的患者45例(静脉化疗组)及直接行宫颈癌根治术的患者45例(未化疗组)的临床资料.对比两组化疗毒副反应、术中出血情况、手术时间、宫颈深肌层浸润率、盆腔淋巴结转移率、脉管癌栓率、阴道切缘的阳性率.结果 静脉化疗组术中出血量、手术时间显著短于未化疗组(t值分别为4.34、5.45,均P<0.05).静脉化疗组患者中胃肠道反应3例,骨髓抑制2例,肝肾功能损伤2例,其他副反应3例(脱发或口腔溃疡等),程度均较轻,经过对症治疗后均好转,未对后续化疗及手术治疗造成影响.静脉化疗组较未化疗组相比宫颈深肌层浸润率、盆腔淋巴结转移率、脉管癌栓率均明显降低(χ2值分别为5.12、4.90、4.87,均P<0.05),两组患者阴道切缘的阳性率相比无显著性差异(χ2=0.26,P>0.05).静脉化疗组术后1年无瘤生存率为93.3%(42/45),显著高于未化疗组1年无瘤生存率75.6%(34/45),χ2=12.25,P<0.05.静脉化疗组术后1年总生存率为97.8%(44/45),显著高于未化疗组1年无瘤生存率84.4%(38/45),χ2=8.93,P<0.05.结论 将新辅助化疗应用于宫颈癌治疗过程中可减少化疗毒副反应,降低转移与浸润,具有积极的临床意义.

Application of neoadjuvant chemotherapy in cervical cancer treatment

Objective To analyze the clinical application of new adjuvant chemotherapy in treatment of cervical cancer.Methods A retrospective analysis was conducted in City Hospital of Obstetrics and Gynecology in Wuhan City from March 2013 to March 2015 among 45 cases of cervical cancer at stage IB2-IIB receiving venous chemotherapy before radical surgery ( venous chemotherapy group) and 45 cases directly undergoing cervical cancer radical surgery ( non-chemotherapy group) .Two groups of patients were compared in toxic and adverse reactions of chemotherapy, intraoperative bleeding, operation time, cervical muscle layer infiltration rate, rate of pelvic lymph node metastasis, vascular cancer, positive rate of vaginal cutting edge.Results The venous chemotherapy group had less intraoperative blood loss and shorter operation time than the non-chemotherapy group (t value was 4.34 and 5.45, respectively, both P<0.05).In venous chemotherapy group there were 3 cases of gastrointestinal reactions, 2 cases of bone marrow suppression, 2 cases of liver and kidney function injury, and 3 cases of other side effects ( such as hair loss or oral ulcer) , and the degree was mild.After symptomatic treatment the symptoms turned better and no effect was made on continued chemotherapy and surgery.Compared to the non-chemotherapy group, the cervical muscle layer infiltration rate, and rates of pelvic lymph node metastasis and vascular tumor emboli reduced significantly in venous chemotherapy group (χ2 value was 5.12, 4.90 and 4.87, respectively, all P<0.05), but two groups were not significantly different in positive rate of vaginal cutting edge (χ2 =0.26, P>0.05).The disease-free survival rate in venous chemotherapy group one year after surgery was 93.3%(42/45), which was significantly higher than that (75.6%, 34/45) in non-chemotherapy group (χ2 =12.25,P<0.05).The overall survival rate one year after surgery was also significantly higher in venous chemotherapy group (97.8%, 44/45) than in non-chemotherapy group (84.4%, 38/45) (χ2 =8.93, P <0.05).Conclusion Neoadjuvant chemotherapy can reduce toxic and adverse reactions of cervical cancer treatment and avoid metastasis and infiltration with positive clinical significance.