CAJ | 학술논문

目的：探讨新辅助化疗（NACT）对ⅠB2~ⅡB期宫颈癌术后病理常见高危因素以及对患者总体生存率的影响。方法：对2003年1月-2013年6月同济大学附属第一妇婴保健院收治的196例ⅠB2~ⅡB期宫颈癌患者进行回顾分析，将其中71例在术前接受了以铂类为基础的NACT的患者作为研究组；将125例进行直接手术（PST）的患者作为对照组。2组均广泛全子宫切除＋盆腔淋巴结清扫术或腹主动脉旁淋巴结切除术，年龄＞45岁者均行双附件切除术。观察NACT组化疗后局部肿瘤体积的变化，对NACT组与PST组术后病理中淋巴结转移、宫颈间质浸润深度、脉管内转移、巨块型、宫旁浸润及阴道切缘肿瘤浸润情况，以及对2组的生存率进行比较。结果：NACT组（统计缺失15例）化疗后肿瘤体积变化：完全缓解（CR）4例（7．1％），部分缓解（PR）27例（48．2％），持续存在（SD）18例（32．1％），肿瘤进展（PD）7例（12．5％）。术后病理分析中，NACT组较PST组，宫体大小及宫颈病灶宽度缩小、淋巴结切除数增多、巨块型宫颈癌中宫颈间质浸润＞1/2的发生率减少，差异有统计学意义（P＜0．05）。但除宫颈间质浸润＞1/2外的其他5个高危因素以及术中出血量、手术时间比较差异无统计学意义（P＞0．05）。 NACT组与PST组生存率比较差异无统计学意义（P＞0．05）。结论：NACT虽然有一定的近期临床疗效，但对于患者的总体生存率没有明显提高，因此在临床应用中需慎重考虑。NACT对控制巨块型宫颈癌术后病理高危因素有一定的效果。巨块型患者经过NACT后再手术是一种比较安全的方法。
목적：탐토신보조화료（NACT）대ⅠB2~ⅡB기궁경암술후병리상견고위인소이급대환자총체생존솔적영향。방법：대2003년1월-2013년6월동제대학부속제일부영보건원수치적196례ⅠB2~ⅡB기궁경암환자진행회고분석，장기중71례재술전접수료이박류위기출적NACT적환자작위연구조；장125례진행직접수술（PST）적환자작위대조조。2조균엄범전자궁절제＋분강림파결청소술혹복주동맥방림파결절제술，년령＞45세자균행쌍부건절제술。관찰NACT조화료후국부종류체적적변화，대NACT조여PST조술후병리중림파결전이、궁경간질침윤심도、맥관내전이、거괴형、궁방침윤급음도절연종류침윤정황，이급대2조적생존솔진행비교。결과：NACT조（통계결실15례）화료후종류체적변화：완전완해（CR）4례（7．1％），부분완해（PR）27례（48．2％），지속존재（SD）18례（32．1％），종류진전（PD）7례（12．5％）。술후병리분석중，NACT조교PST조，궁체대소급궁경병조관도축소、림파결절제수증다、거괴형궁경암중궁경간질침윤＞1/2적발생솔감소，차이유통계학의의（P＜0．05）。단제궁경간질침윤＞1/2외적기타5개고위인소이급술중출혈량、수술시간비교차이무통계학의의（P＞0．05）。 NACT조여PST조생존솔비교차이무통계학의의（P＞0．05）。결론：NACT수연유일정적근기림상료효，단대우환자적총체생존솔몰유명현제고，인차재림상응용중수신중고필。NACT대공제거괴형궁경암술후병리고위인소유일정적효과。거괴형환자경과NACT후재수술시일충비교안전적방법。
Objective:To discuss the impact of neoadjuvant chemotherapy (NACT) on high-risk factors as frequently reported by post-surgical pathology and the overall survival rate in patients with stage ⅠB2-ⅡB cervical cancer. Methods:A retrospective analysis was performed on the clinical data from 196 patients of stages ⅠB2-ⅡB cervical cancer admitted to First Maternity and Infant Hospital Affiliated to Tongji University during January 2003 to June 2013. Patients were divided into two groups: 71 cases received pre-surgical NACT based on platinum and taxol (NACT group) and 125 cases received primary surgical treatment (PST group) without pre-surgical NACT. Both groups received radical hysterectomy, bilateral salpingo-oophorectomy(age>45 years old) plus pelvic lymph node dissection with or without para-aortic lymphadenectomy. In the NACT group, reduction in tumor size was observed after chemotherapy. Pelvic lymph node metastasis, depth of myometral invasion, lympho-vascular space invasion, bulky tumor, parametrial invasion, positive vaginal resection margin and survival rates were compared between the two groups. Results:In NACT group, data missing were 15 cases, 4 cases (7.1%) had complete remission (CR), 27 cases (48.2%) had partial remission (PR), 18 cases (32.1%) were stable disease (SD) and 7 cases (12.5%) were progression of disease (PD). Compared with the PST group, patients in NACT group had greater reduction in the size of uterus and width of cervical lesion, more lymph nodes dissected, and fewer bulky tumors with≥50%thickness myometrial invasion (all P<0.05). There were no statistically significant differences in other 5 high-risk factors and blood loss, duration of operation, the overall survival rate between the two groups (all P>0.05). Conclusions:Neoadjuvant chemotherapy has certain recent clinical curative effects, however, did not improve the overall survival rate, therefore, doctors should carefully consider the clinical application of NACT. Neoadjuvant chemotherapy has a certain effect on controling pathologic risk factors of the bulky cervical cancer after surgery. Accordingly, for massive type, surgery after neoadjuvant chemotherapy will be a safe treatment.