【摘要】 目的通过中国宫颈癌临床病理大数据调查,分析中国大陆部分医院宫颈癌术前新辅助化疗的临床应用特点及变化趋势,为探讨适应中国国情的宫颈癌规范诊疗提供研究基础及数据支持。方法从宫颈癌大数据库中收录的2004—2016年34家医院31 599例数据中调取术前新辅助化疗病例4503例,对其临床和病理资料进行回顾性分析。结果汇总第一阶段31 599例宫颈癌数据中,手术病例25 542例,其中术前新辅助化疗病例4503例,在宫颈癌手术病例中占比为17.6%;纳入研究的4503例术前化疗病例平均年龄(46.82±8.97)岁。近13年来随时间推移,年龄呈上升趋势。局部晚期(ⅠB2、ⅡA2、ⅡB)为术前新辅助化疗病例的主要构成部分(占比分别为27.7%、15.5%、23.4%),其中ⅠB2、ⅡA2期,即肿块型占比随时间有上升趋势。进一步将肿瘤直径分层,直径在>4~6.0 cm的病例在新辅助化疗中占比最高且逐年增加。病理类型的构成比依次为鳞癌82.3%、腺癌6.8%、腺鳞癌1.1%、神经内分泌癌0.8%、透明细胞癌0.2%、其他病理类型(如黑色素瘤、淋巴上皮样癌等)0.8%,随时间变化并无线性趋势改变。组织学分级低分化占比呈增高趋势。给药途径动脉化疗、静脉、动静脉联合化疗分别占比为21.3%、75.3%、2.8%。静脉化疗占比逐年升高,动脉化疗比率下降。化疗药物多以铂类为基础,动脉化疗疗程数1~3个疗程,1个疗程占比最高90.1%。静脉化疗疗程数为1~4个疗程,2个疗程占比最高58.6%。结论在中国,术前新辅助化疗在宫颈癌治疗中占据重要地位,近13年来,其在临床分期、病理分级、给药途径、化疗方案、疗程等方面都发生了变迁,针对宫颈癌新辅助化疗的临床特点和变化趋势,探索相应规范的治疗模式十分必要。更多还原

【Abstract】 Objective To analyze the clinical characteristics and trends of neoadjuvant chemotherapy(NACT)for cervical cancer by investigating the clinical pathological data of cervical cancer in some hospitals in China,and provide the research basis and data support for the standardized diagnosis and treatment of cervical cancer in China.Methods A retrospective study was performed on the clinical and pathological data of 4503 cases of neoadjuvant chemotherapy from 31 599 cervical cancer cases from 2004 to 2016 in the large database of cervical cancer from 34 hospitals in China.Results In total,31 599 cases were included in the current analysis.There were25 542 surgical cases,and 4503 cases of neoadjuvant chemotherapy,accounting for 17.6%.The average age of NACT in 4503 cases was 46.82 ± 8.97 years old.In the past 13 years,the age of treatment has been on the rise.Locally advanced(ⅠB2,ⅡA2,ⅡB)were the main components of NACT cases(accounting for 27.7%,15.5%,23.4%,respectively).Among them,the proportion of ⅠB2,ⅡA2 stage(mass type)has an upward trend with time.According to tumor diameter,the cases with diameter of>4-6.0 cm accounted for the highest proportion in NACT and the proportion appeared an upward trend.The ratio of squamous carcinoma 、adenocarcinoma 、adenosquamous carcinoma、neuroendocrine carcinoma,clear cell carcinoma、other pathological types(such as melanoma,lymphatic epithelial carcinoma)were 82.3%、6.8%、1.1%、0.8%、0.2%、0.8%,respectively.There was no linear trend change.The ratio of poorly differentiated showed a trend of increase in neoadjuvant chemotherapy of cervical cancer,The ratio of artery,intravenous,and arteriovenous chemotherapy were 21.3%,21.3% and 21.3%respectively.Over time,the rate of intravenous chemotherapy has been on the rise.Chemotherapy drug was mostly based on platinum-based.The number of arterial chemotherapy courses was 1-3,1 course was highest accounted for 90.1%,Intravenous chemotherapy included 1-4 courses,2 course was highest accounted for 58.6%.Conclusion In China,neoadjuvant chemotherapy in the treatment of cervical cancer occupies an important position.Nearly 13 years,the clinical stage,pathological grade,routes of administration,chemotherapy,medication and other aspects have undergone changes.According to the clinical characteristcs and trends of neoadjuvant chemotherapy in cervical cancer,it is more necessary to explore a standard treatment mode.更多还原