不同方式新辅助化疗在宫颈鳞癌中的疗效观察

[摘要] 目的 探讨不同方案的新辅助化疗对局部晚期或巨块形Ⅰb~Ⅲa期宫颈癌的治疗的疗效。方法 回顾性研究2002～2006年我院185例Ⅰb~Ⅲa宫颈鳞状上皮癌患者，按新辅助化疗方式分为三组，组1：动脉灌注卡铂，组2：动脉灌注卡铂+紫杉醇，组3：静脉滴注卡铂+紫杉醇；随后行根治性手术，术后随访5年。比较各组间疗效、淋巴结转移率及生存时间。 结果 化疗疗效情况：组1与组2之间差异无统计学意义，而两组与组3之间差异有统计学意义；组1、2较组3新辅助化疗术后宫旁累及淋巴结转移相比，差异有统计学意义（P ＜ 0.05）； 三组复发率分别是1.78%、0、4.47%，三组间差别无统计学意义。 结论 3种新辅助化疗对于局部晚期宫颈癌能有效缩小肿瘤体积、提高手术切除率、降低复发转移；卡铂单药动脉灌注化疗方案是对宫颈鳞癌新辅助化疗有效的方案。

[关键词] 子宫颈鳞癌；新辅助化疗；卡铂；紫杉醇

[中图分类号] R737.33 [文献标识码] B [文章编号] 1673-9701（2012）16-0026-03

Comparison of therapeutic effects between different types of neoadjuvant chemotherapy on squamous cell carcinoma of cervix

FANG Weida1 HAN Yi1 HE Ke2 NIU Gang2

1.Department of Oncology, Kaiping Central Hospital in Guangdong Province, Kaiping 529300, China; 2.Department of Gynaecology, the First Affiliated Hospital Sun Yatsen University, Guangzhou 510080, China.

[Abstract] Objective To compare the therapeutic effect between different types of neoadjuvant chemotherapy on bulky or locally advanced cervical cancer. Methods A retrospective study was carried out on 185 patients with stage Ⅰb~Ⅲa cervical squamous cell carcinoma admitted to our hospital from 2002 to 2006. The patients were divided into 3 groups according to the types of neoaduvant chemotherapy. group 1: carboplatin intra-arterial infusion；group 2: carboplatin+ paclitaxel intra-arterial infusion; group3: carboplatin+paclitaxel intra-venous infusion. All patients received operation after chemotherapy and were followed up for 5 years. There were no significant difference between the 3 groups in age, FIGO stage or pathology (P ＞ 0.05). Results Staitsical index includes multiple prognosis factors such as parametrial involvement, lymphatic metastasis, surgical margin, side effect, recession rate and survival rate. There were significant difference in parametrial involvement (P ＜ 0.05), lymphatic metastasis (P ＜ 0.05) and tumor size ＜0.002). There were no significant difference in side effect, surgical margin. The recurrence rate in 3 groups were 1.78%, 0, 4.47% respectively. Conclusion Three program of neoadjuvant chemotherapy were safe and effective for locally advanced cervical cancer, reduced the relapse and metastasis. Single agent of carboplatin intra-arterial infusion is effective on squamous cell carcinoma of cervix.

[Key words] Squamous cell carcinoma of cervix; Neoaduvant chemotherapy; CBP; PTX

宫颈癌是全球妇女中仅次于乳腺癌的第二位最常见的恶性肿瘤，在我国妇科恶性肿瘤发病率中居第一位[1]。目前国内发病率约9.98/10万，死亡率为3.89/10万[2]，宫颈癌治疗方式早、中期仍以外科手术治疗和放疗为首选，其选择与临床分期、分化程度、肿瘤大小等因素有关。化疗作为综合治疗的一部分，过去主要应用于中、晚期宫颈癌的姑息性治疗，目前经过大量的临床试验结果确定了化疗在宫颈癌治疗中的地位，并且越来越重视新辅助化疗的作用。虽然多数资料显示，NACT对Ⅰb2期、Ⅱa 期、部分Ⅱb期宫颈癌，尤其是巨块型（最大径≥4 cm）患者获益， 但至今仍然没有标准的化疗方案和给药方式[3]。本实验对Ⅰb～Ⅲa 期巨块型宫颈鳞癌应用3种新辅助化疗方式，观察疗效及不良反应。