宮頸癌術(shù)前新輔助化療探討

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1、宮頸癌術(shù)前新輔助化療探討研究生:楊筱導(dǎo)師:彭芝蘭教授中文摘要目的:探討宮頸癌術(shù)前新輔助化療(NeoadjuvantChemotherapy,NACT)對于改善宮頸癌患者近期療效與遠(yuǎn)期預(yù)后的作用。方法:1991一2001年間四川大學(xué)華西第二醫(yī)院行宮頸癌根治手術(shù)(廣泛子宮切除術(shù)+淋巴結(jié)清掃術(shù))的患者619例，納入其中巨塊型宮頸癌(宮頸局部癌灶直徑大于4cm)的IB-IIIB期患者228例，按治療方法分為3組;ONACT+S組:術(shù)前接受BP方案(BLM+DDP)的新輔助化療的患者(n=63),②RT+S組:術(shù)前給予放療的

2、患者(n=11),OS組:同期單純手術(shù)患者(n=154),②③兩組為對照組。觀察指標(biāo):1、術(shù)前NACT對宮頸癌的療效;2、三組患者術(shù)后病理分期與術(shù)前臨床分期間的差異，切緣陽性率及淋巴結(jié)轉(zhuǎn)移率;3、三組患者手術(shù)質(zhì)量相關(guān)情況:手術(shù)失血量、術(shù)后并發(fā)癥、術(shù)后尿管留置時(shí)間;4、三組患者的五年生存率。結(jié)果:NACT對巨塊型宮頸癌有良好的療效(CR+PR=83Yo)，且動(dòng)脈介入化療與靜脈全身化療的療效沒有明顯差別;NACT十S組在降低分期方面優(yōu)于RT+S組及S組(P<0.05);切緣陽性率及淋巴結(jié)轉(zhuǎn)移率低于RT+S組及S組，但差

3、別無統(tǒng)計(jì)學(xué)意義(P>0.05);手術(shù)質(zhì)量相關(guān)因素比較:NACT+S組手術(shù)失血量、術(shù)后留置尿管時(shí)間均低于S組〔P<0.05),與RT+S組的差別無統(tǒng)計(jì)學(xué)意義(P>0,05);術(shù)后并發(fā)癥低于RT+S組及S組，但差別無統(tǒng)計(jì)學(xué)意義(P>0.05);所有化療病例均未出現(xiàn)不能耐受的毒副作用;三組患者之間五年生存率無明顯統(tǒng)計(jì)學(xué)差異(P>0.05).結(jié)論:1,BP方案的新輔助化療對巨塊型宮頸癌安全而有效;2、新輔助化療降分期的作用確切;3、新輔助化療有助于改善手術(shù)質(zhì)量;4,尚不能證明新輔助化療對于宮頸癌患者的五年生存率有改善的作用

4、。關(guān)鍵詞宮頸癌化學(xué)療法廣泛子宮切除術(shù)放射療注Pre-operativeNeoadjuvantChemotherapyFollowedbyRadicalSurgeryintheTreatmentofCervicalCarcinoma尸ostgraduateYangXiaoProfessorPengZhilanAbstractOBJECTIVE:ToinvestigatetheefectofNeoadjuvantChemotherapy(NACT)oncervicalcarcinoma.METHODS:Among619

5、patientsexperiencedradicalsurgery(radicalhysterectomy+lymphadenectomy)forcervicalcarcinoma,228patientswithdiameteroflocallesions>4cmandstage(FIGO)fromIB-111Bwereincludedinourstudy.Patientsweredividedinto3groupsaccordingtodiferenttreatments:1)NACT+Sgroup(n=63):

6、patientsacceptedNACTwithBleomycinandCisplatin,2)RT+Sgroup(n=11):patientsunderwentprimaryradiotherapy,2)Sgroup(n=154):patientswenttoradicalsurgerydirectly.Theresponserateoftumor,downstagingefect,lymphnodemetastasisandtumorpositiverateoftheincisalmarginwereobser

7、ved;Andwealsocomparedtheoperativequalityrelatingfactorsandfive-yearsurvivalrateamongthethreegroups;ThesideefectsoftheNACTwerereviewed,too.RESULTS:TheresponseratetoNACTissatisfying(CR+PR=83%);ThedownstagingeffectofNACTisconfirmed(P<0.05);Asfarasfactorsrelatedto

8、surgeryqualityareconcerned,NACT+SgroupissuperiortoSgroupandRT+Sgrouponthewhole;AndthereisnoseveresideeffectresultedfromNAC又Whencometofive-yearsurvivalrate,thereisnodiferencewithsta