CAJ | 학술논문

目的：观察并对比奥沙利铂（L - OHP）、顺铂（DDP）分别联合多西紫杉醇（DTX）方案用于 Ib -Ⅱa 期宫颈癌患者新辅助化疗的近远期疗效与安全性，优化临床治疗方案。方法将2010~2011年收治的103例择期行根治术的 Ib -Ⅱa 期宫颈癌患者随机分为 A、B 两组，A 组53例患者术前予 DTX 联合 L - OHP 化疗方案，B 组予 DTX 联合 DDP方案，2周为1化疗周期，连续化疗3个周期，化疗结束后2~3周适情行广泛子宫切除术并盆腔淋巴结清扫，对比两组化疗后近期疗效、化疗期间毒性反应并2年复发率。结果新辅助化疗结束后，A 组 KPS 评分（82.6±5.7）明显高于 B组（80.4±5.3）（ t =2.025，P =0.046），A 组总有效率（67.9%）和临床获益率（94.3%）均高于 B 组（54.0%、86.0%），差异无统计学意义（ P >0.05）。化疗期间，A 组中性粒细胞减少（11.3% vs.28.0%）、血小板减少（5.7% vs.16.0%）、肾功损害（3.8% vs.14.0%）、脱发（32.1% vs.42.0%）等发生率大幅低于 B 组，两组中性粒细胞减少比率差异有统计学意义（χ2=4.574，P =0.032）。术中，A、B 两组宫旁组织及淋巴结癌阳性率（6.0% vs.11.6%）无显著性差异（fisher P=0.464）。术后2年 A、B 两组复发率（2.4% vs.5.3%）无显著差异（fisher P =0.498）。结论 Ib -Ⅱa 期宫颈癌患者术前采用 DTX 联合 L - OHP 化疗方案较 DTX 联合 DDP 方案在近期疗效方面具有比较优势，在降低骨髓抑制等毒性反应方面优势明显。
목적：관찰병대비오사리박（L - OHP）、순박（DDP）분별연합다서자삼순（DTX）방안용우 Ib -Ⅱa 기궁경암환자신보조화료적근원기료효여안전성，우화림상치료방안。방법장2010~2011년수치적103례택기행근치술적 Ib -Ⅱa 기궁경암환자수궤분위 A、B 량조，A 조53례환자술전여 DTX 연합 L - OHP 화료방안，B 조여 DTX 연합 DDP방안，2주위1화료주기，련속화료3개주기，화료결속후2~3주괄정행엄범자궁절제술병분강림파결청소，대비량조화료후근기료효、화료기간독성반응병2년복발솔。결과신보조화료결속후，A 조 KPS 평분（82.6±5.7）명현고우 B조（80.4±5.3）（ t =2.025，P =0.046），A 조총유효솔（67.9%）화림상획익솔（94.3%）균고우 B 조（54.0%、86.0%），차이무통계학의의（ P >0.05）。화료기간，A 조중성립세포감소（11.3% vs.28.0%）、혈소판감소（5.7% vs.16.0%）、신공손해（3.8% vs.14.0%）、탈발（32.1% vs.42.0%）등발생솔대폭저우 B 조，량조중성립세포감소비솔차이유통계학의의（χ2=4.574，P =0.032）。술중，A、B 량조궁방조직급림파결암양성솔（6.0% vs.11.6%）무현저성차이（fisher P=0.464）。술후2년 A、B 량조복발솔（2.4% vs.5.3%）무현저차이（fisher P =0.498）。결론 Ib -Ⅱa 기궁경암환자술전채용 DTX 연합 L - OHP 화료방안교 DTX 연합 DDP 방안재근기료효방면구유비교우세，재강저골수억제등독성반응방면우세명현。
Objective To observe and compare short and long term efficacy and safety between oxaliplatin(L - OHP)/ docetaxel(DTX) regimen and cis - platin(DDP)/ DTX regimen for neoadjuvant chemotherapy of Ib - Ⅱa cervical carcinoma,and to optimize treatment plan. Methods One hundred and three Ib - Ⅱa cervical carcinoma patients who underwent radical resection during 2010 ~ 2011 were randomly divided into group A(n = 53)and group B(n = 50). Patients in both received neoadjuvant chemotherapy,group A was treated with L - OHP/ DTX, group B was treated with DDP/ DTX regimen,2 weeks for 1 treatment cycle,and continuously for 3 cycles. 2 - 3 weeks after neoadjuvant chemo-therapy,extensive hysterectomy and pelvic lymph node dissection were implemented,and short term efficacy,toxicity reactions and 2 years recur-rence rate of 2 groups were compared. Results After neoadjuvant chemotherapy,KPS score in group A(82. 6 + 5. 7)was higher than group B (80. 4 + 5. 3)( t = 2. 025,P = 0. 046). The total effective rate of group A(67. 9% )and clinical benefit rate(94. 3% )in group A were higher than group B(54. 0% and 86. 0% ,respectively),but no significant differences( P > 0. 05). During chemotherapy,incidence of neutropenia, thrombocytopenia,renal damage,and hair loss in group A and group B were11. 3% vs. 28. 0% ,5. 7% vs. 16. 0% ,3. 8% vs. 14. 0% ,and 32. 1% vs. 42. 0% ,respectively. There was statistically significant difference in neutropenia ratio(χ2 = 4. 574,P = 0. 032). During operation,no significant difference in parametrial tissue and lymph node cancer positive rate was found between group A and group B(6% vs. 11. 6% )(fisher P = 0. 464). Two years after surgery,the recurrence rate in group A and group B(2. 4% vs. 5. 3% )had no significant difference(Fisher P =0. 498). Conclusion Compared with DDP/ DTX regimen,L - OHP/ DTX neoadjuvant chemotherapy has comparative advantages in short term ef-ficacy for Ib - Ⅱa cervical carcinoma,and has obvious advantages in reduction of bone marrow inhibition.