新辅助化疗对ⅠB2~B期宫颈癌的临床疗效观察.

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 stageⅠB2-ⅡB cervical cancer. Methods: A retrospective analysis was performed on the clinical data from 196 patients of stagesⅠB2-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. [ABSTRACT FROM AUTHOR]