【摘要】 目的探讨局部晚期宫颈癌新辅助化疗的疗效及影响近期疗效的相关因素,以及对患者长期生存的影响。方法收集行新辅助化疗的Ⅰb2～Ⅱb期局部晚期宫颈癌患者64例,分析其化疗后的近期疗效及长期生存率,采用多元线性回归法分析影响化疗近期疗效的相关因素。结果新辅助化疗的近期总有效率为80%(51/64)。化疗患者的近期疗效与病理类型有关,鳞癌患者的有效率(82%)明显高于腺癌(6/9,P<0.05);而与其他因素无关(P>0.05)。化疗有效者手术后盆腔淋巴结阳性率为8%(4/51),宫旁血管癌栓阳性率为2%(1/51),均明显低于化疗无效者(分别为3/6、2/6;P<0.05)。新辅助化疗后患者的总5年生存率为89%,其中化疗有效者5年生存率为100%,明显高于化疗无效者的46%(P<0.05)。新辅助化疗有效者3、5年无瘤生存率分别为95%、83%,化疗无效者分别为33%、0,两者分别比较,差异均有统计学意义(P<0.05)。结论局部晚期宫颈癌新辅助化疗的近期疗效与病理类型有关,对化疗有效者应选择手术,可提高长期生存率。更多还原

【Abstract】 Objective To investigate the effect of neoadjuvant chemotherapy on locally advanced cervical cancer, the factors affecting outcome of chemotherapy and the long-term survival rate in the patients. Methods A total of 64 patients with stageⅠb2-Ⅱb of locally advanced cervical cancers treated with neoadjuvant chemotherapy between June 1999 and October 2004 in Women′s Hospital, School of Medicine, Zhejiang University were retrospectively analysed. The effect of chemotherapy, as well as survival rate was evaluated. The related factors of effect, including age, histology, clinical stage, grade of differentiation, initial tumor size, chemotherapy regimens, number of courses were analysed. Results Overall effective rate of neoadjuvant chemotherapy was 80%. The effective rate was associated with histology. The patients with squamous cell cancer had significantly higher 5-year survival rate than those with adenocarcinoma (82% vs 6/9, P<0.05). The rates of positive pelvic lymph node metastasis and parametrial invasion were significantly higher in complete or partial response patients than those in stable patients(P<0.05). The overall 5-year survival rate was 89%. The 5-year survival rate in complete or partial response group was 100%,in stable disease group was 46%( P<0.05). The 3,5-year disease-free survival rate in complete or partial response group was 95% and 83%,respectively, while in stable disease group was 33% and 0,respectively. The disease-free survival rates in complete or partial response group were higher than those of stable disease group(P<0.05). Conclusions The clinical response to neoadjuvant chemotherapy is related to histology. The patients who have good response to chemotherapy should choose surgery. Chemotherapy can decrease the high risk factors of pathology in complete or partial response patients. Neoadjuvant chemotherapy for locally advanced cervical cancer patients seems to improve the long-term survival rate.更多还原