不同方式治疗局部晚期宫颈癌预后分析

高龙飞; 刘健

doi:10.16766/j.cnki.issn.1674-4152.002361

不同方式治疗局部晚期宫颈癌预后分析

doi: 10.16766/j.cnki.issn.1674-4152.002361

高龙飞,
刘健^,

蚌埠医学院第一附属医院肿瘤妇科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2019A0363

详细信息

通讯作者:
刘健，E-mail：elitelj@126.com

中图分类号: R737.33 R730.5
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-21
- 网络出版日期: 2022-08-13

Prognostic analysis of different treatments for locally advanced cervical cancer

GAO Long-fei,
LIU Jian^,

Department of Oncology and Gynaecology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨新辅助化疗联合手术(neoadjuvant chemotherapy and radical surgery，NACT+RS)与单纯手术(radical surgery，RS)对局部晚期宫颈癌预后的影响。方法收集2013年1月—2015年12月蚌埠医学院第一附属医院妇瘤科收治的119例局部晚期宫颈癌患者，依照治疗方式不同分为NACT+RS组74例，RS组45例，其中NACT+RS组根据化疗疗效分为有效组45例，无效组29例。比较NACT+RS组与RS组手术时间、术中出血量、术后病理特征及5年生存情况，比较NACT有效组与RS组术后病理特征及5年生存情况, 评价NACT有效联合手术对患者生存的影响。结果 NACT+RS组与RS组相比，术中出血量、手术时间、淋巴结转移、肌层浸润及5年生存率差异均无统计学意义(均P＞0.05)。NACT+RS组术中出血量较RS组少，差异有统计学意义(P＜0.05)。而NACT有效组与RS组淋巴结转移阳性率分别为4.4%、17.8%，差异有统计学意义(χ²=4.050, P=0.044)，深肌层浸润率分别为20.0%、55.6%，差异有统计学意义(χ²=12.101, P=0.001)。NACT有效组5年生存率为93.3%，相对于RS组的73.3%, 差异有统计学意义(χ²=6.480, P=0.011)。结论相对于单纯手术，新辅助化疗有效联合手术降低了淋巴结转移及肌层浸润率并能明显改善患者远期预后。
- 局部晚期宫颈癌 /
- 新辅助化疗 /
- 手术
Abstract: Objective To investigate the effect of neoadjuvant chemotherapy and radical surgery (NACT+RS) and surgery alone (radical surgery, RS) on the prognosis of locally advanced cervical cancer. Methods From January 2013 to December 2015, 119 patients with locally advanced cervical cancer were divided into the NACT+RS group (n=74) and the RS group (n=45). According to the curative effect of chemotherapy, the NACT+RS group was divided into an effective group (n=45) and an ineffective group (n=29). The operation time, intraoperative blood loss, post-operative pathological features and 5-year survival between the NACT+RS and RS groups were compared, and the post-operative pathological features and 5-year survival between the NACT effective group and the RS group were compared to evaluate the effect of NACT combined operation on patient survival. Results No significant difference in intraoperative blood loss, operation time, lymph node metastasis, myometrial invasion and 5-year survival rate was found between the NACT+RS and RS groups. The amount of intraoperative blood loss in NACT+RS group was significantly less than that in RS group (P < 0.05). Compared with that in the NACT effective group, the positive rate of lymph node metastasis in the RS group was 4.4% and 17.8%, respectively, and the difference was statistically significant (χ²=4.050, P=0.044). In addition, the deep muscle infiltration rate was 20.0%, 55.6%, respectively, and the difference was statistically significant (χ²=12.101, P=0.001). The 5-year survival rate of the NACT effective group was 93.3%, whereas that of the RS group was 73.3% (χ²=6.480, P=0.011). Conclusion Compared with simple operation, neoadjuvant chemotherapy combined with surgery can reduce lymph node metastasis and myometrial invasion and improve the long-term prognosis of patients.
- Locally advanced cervical cancer /
- Neoadjuvant chemotherapy /
- Surgery

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图 1 NACT有效组和RS组局部晚期宫颈癌患者的生存曲线

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表 1 2组局部晚期宫颈癌患者临床资料比较

Table 1. Comparison of clinical data between 2 groupsof patients with local advanced cervical cancer

组别	例数	年龄 (x±s，岁)	临床分期[例(%)]		病理类型[例(%)]
组别	例数	年龄 (x±s，岁)	ⅠB2	ⅡA2	鳞癌	腺癌
NACT+RS组	74	49.47±8.25	44(59.5)	30(40.5)	71(95.9)	3(4.1)
RS组	45	50.51±8.94	23(51.1)	22(48.9)	40(88.9)	5(11.1)
统计量		0.645^a	0.793^b		1.239^b
P值		0.520	0.373		0.266
注：^a为t值，^b为χ²值。

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表 2 2组局部晚期宫颈癌患者术后病理特点比较[例(%)]

Table 2. Comparison of postoperative pathological characteristics between 2 groups of patientswith locally advanced cervical cancer [cases (%)]

组别	例数	脉管浸润		淋巴结转移		肌层侵犯		累及宫颈管
组别	例数	阳性	阴性	阳性	阴性	浅肌层	深肌层	有	无
NACT+RS组	74	4(5.4)	70(94.6)	16(21.6)	58(78.4)	44(59.5)	30(40.5)	12(16.2)	62(83.8)
RS组	45	4(8.9)	41(91.1)	8(17.8)	37(82.2)	20(44.4)	25(55.6)	22(48.9)	23(51.1)
χ²值		0.128		0.257		2.538		14.637
P值		0.720		0.612		0.111		＜0.001

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表 3 2组局部晚期宫颈癌患者术后病理特点比较[例(%)]

Table 3. Comparison of postoperative pathological characteristics between 2 groups of patientswith locally advanced cervical cancer [cases (%)]

组别	例数	脉管浸润		淋巴结转移		肌层侵犯		累及宫颈管
组别	例数	阳性	阴性	阳性	阴性	浅肌层	深肌层	有	无
NACT有效组	45	3(6.7)	42(93.3)	2(4.4)	43(95.6)	36(80.0)	9(20.0)	6(13.3)	39(86.7)
RS组	45	4(8.9)	41(91.1)	8(17.8)	37(82.2)	20(44.4)	25(55.6)	22(48.9)	23(51.1)
χ²值		＜0.001		4.050		12.101		13.272
P值		0.999		0.044		0.001		＜0.001

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