CAJ | 학술논문

目的比较术前子宫动脉灌注化疗栓塞和静脉化疗治疗年轻宫颈癌患者的临床疗效和不良反应。方法回顾性分析241例年龄≤35岁宫颈癌患者的临床资料，其中术前子宫动脉灌注化疗栓塞联合手术治疗63例（A组），术前静脉化疗联合手术治疗57例（B组），化疗方案为卡铂（50 mg/m2）联合吉西他滨（1000 mg/m2）。比较两组的近期疗效、术中出血量、术后病理结果及不良反应。 Kaplan-Meier法计算生存率等并Log-rank法检验。结果 A组近期有效率（90.5%）明显高于B组（71.9%）（χ2=7.5，P＜0.05）。 A组手术切除率（95.2％）高于B组（84.2％）。 A组术中出血量（443±263）ml，B组术中出血量（695±312）ml，差异有统计学意义（t=4.802，P＜0.05）。 A组9.5%（6/63）达到病理完全缓解，B组5.3%（3/57）达到病理完全缓解，两组术后病理结果差异有统计学意义（χ2=12.3，P＜0.05）。 A组的不良反应较B组轻（P＜0.05）。A、B两组5年无进展生存率（PFS）分别为73.0%、54.4%（χ2=4.471，P＜0.05），总生存率（0S）为77.8%与63.2%（χ2=3.022，P＞0.05）。临床分期、组织学分级、肿瘤大小（最大径≥4.5 cm）均是影响年轻宫颈癌OS的预后因素（P＜0.05）。结论术前子宫动脉灌注化疗栓塞治疗年轻宫颈癌的近期疗效优于术前静脉化疗，且不良反应轻，能提高无进展生存率，但长期生存率提高不明显。
목적비교술전자궁동맥관주화료전새화정맥화료치료년경궁경암환자적림상료효화불량반응。방법회고성분석241례년령≤35세궁경암환자적림상자료，기중술전자궁동맥관주화료전새연합수술치료63례（A조），술전정맥화료연합수술치료57례（B조），화료방안위잡박（50 mg/m2）연합길서타빈（1000 mg/m2）。비교량조적근기료효、술중출혈량、술후병리결과급불량반응。 Kaplan-Meier법계산생존솔등병Log-rank법검험。결과 A조근기유효솔（90.5%）명현고우B조（71.9%）（χ2=7.5，P＜0.05）。 A조수술절제솔（95.2％）고우B조（84.2％）。 A조술중출혈량（443±263）ml，B조술중출혈량（695±312）ml，차이유통계학의의（t=4.802，P＜0.05）。 A조9.5%（6/63）체도병리완전완해，B조5.3%（3/57）체도병리완전완해，량조술후병리결과차이유통계학의의（χ2=12.3，P＜0.05）。 A조적불량반응교B조경（P＜0.05）。A、B량조5년무진전생존솔（PFS）분별위73.0%、54.4%（χ2=4.471，P＜0.05），총생존솔（0S）위77.8%여63.2%（χ2=3.022，P＞0.05）。림상분기、조직학분급、종류대소（최대경≥4.5 cm）균시영향년경궁경암OS적예후인소（P＜0.05）。결론술전자궁동맥관주화료전새치료년경궁경암적근기료효우우술전정맥화료，차불량반응경，능제고무진전생존솔，단장기생존솔제고불명현。
Objective To compare the efficacy and side-effects of preoperative neoadjuvant uterine arterial chemoembolization and venous chemotherapy in treating cervical cancer in young female patients. Methods A total of 241 young females(≤35 years old) with cervical cancer were enrolled in this study. The clinical data were retrospectively analyzed. The patients were divided into group A (n=63) and group B (n=57). Patients in group A received preoperative neoadjuvant uterine arterial chemoembolization with subsequent surgery, while patients in group B were treated with preoperative neoadjuvant intravenous chemotherapy followed by surgery. The chemotherapy scheme included carboplatin (50 mg/m2) and gemcitabine (1 000 mg/m2). The short-term effect, the amount of blood loss during the surgery, pathological findings and the side-effects of the two groups were compared. The Kaplan-Meier method was used to calculate survival rate, and the log-rank test was used for survival difference analysis. Results The short-term response rate of group A was 90.5%, which was significantly higher than that of group B (71.9%), the difference between the two groups was statistically significant (χ2=7.5, P<0.05). The resection rate of group A was 95.2%, which was higher than that of group B (84.2%). The amount of intra-operative blood loss of group A and group B was (443±263) ml and (695±312) ml respectively, the difference was statistically significant (t=4.802, P<0.05). The pathological complete remission of group A and group B was 9.5%(6/63) and 5.3%(3/57)respectively; the differences in postoperative pathological results between the two groups were statistically significant (χ2=12.3, P<0.05). The side effect of group A was milder than that of group B (P<0.05). The 5-year progression-free survival (PFS) rate of group A and group B was 73.0% and 54.4% respectively (χ2=4.471, P<0.05);and the overall survival (OS) rate of group A and group B was 77.8%and 63.2%respectively (χ2=3.022, P>0.05). In both groups, the clinical stage, the pathological grade and the size (≥ 4 cm) of the tumor were the main factors that could influence the prognosis in young females with cervical cancer (P<0.05). Conclusion The short-term efficacy of preoperative uterine artery chemoembolization is better than that of preoperative intravenous chemotherapy for the treatment of cervical cancer in young female patients. Besides, this therapy carries mild side effect, and it can improve the 5-year progression-free survival rate, although the long-term survival rate has not been obviously improved.