新辅助化疗后根治性手术与同步放化疗在局部晚期宫颈癌的远期疗效评价

摘要

目的 本研究的目的 是比较ⅠB2~ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术与同步放化疗的远期生存情况. 方法 回顾性分析从2000年1月-2004年12月间ⅠB2~ⅡB期局部晚期宫颈癌共222例,将其分为二组:新辅助化疗+根治性全子宫切除术+盆腔淋巴结切除术共155例;同步放化疗组67例.所有患者最长随访时间为114个月,最短随访时间为54个月,中位随访时间为72.6个月.且对所有可能影响无瘤生存时间和总生存时间的高危因素进行评估. 结果 本研究中位随访时间为72.6个月,新辅助化疗后根治性手术组和同步放化疗组5年无瘤生存率分别是88.39%和70.94%,两组比较有统计学意义(P=0.006);而5年总生存率分别为88.52%和72.91%,两组比较有统计学意义(P=0.0004).在Cox风险回归模型中,调整宫颈癌患者的年龄、病理分型后,结果显示:接受新辅助化疗后根治性手术组和同步放化疗组治疗的宫颈癌患者5年无瘤生存时间有明显差异(HR=2.765,95%CI:1.446~5.288,P=0.0021);在5年总生存时间上也有显著性差异(HR=3.516,95%CI:1.822~6.784,P=0.0002). 结论 本研究ⅠB2~ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术组在无瘤生存时间和总生存时间方面显著优于同步放化疗组.%Objective The purpose of this study is to compare long - term survival of neoadjuvant chemotherapy followed by radical hysterectomy with concurrent chemoradiotherapy in locally advanced cervical cancer.Methods A total of 222 stage Ⅰ B2 - Ⅱ B locally advanced cervical cancer cases from January 2000 to December 2004 were analyzed retrospectivly. All the cases were divided into two groups:155 cases of neoadjuvant chemotherapy followed by radical hysterectomy with pelvic lymph node dissection( NACT + RS group );67 cases of concurrent chemoradiotherapy group( CCRT group ). Patients were followed up from 54 to 114 months. NACT group patients were followed up for more than 72.6 months, all risk factors that may affect the disease - free survival( DFS )and overall survival( OS )were assessed. The NACT + RS group had significantly higher survival rates than both the CCRT( DFS : hazard ratio = 2.765,P=0.0021 ; OS : hazard ratio = 3.516 , P = 0.0002 )groups. Results In this study,median follow - up time was 72.6 ruonths, the five - year DFS rates of the NACT + RS and CCRT groups were 88.39％ and 70.94％ , respectively( P = 0.006 ) , while the five-year OS rates were 88.52％and 72.91％ ,respectively( P = 0.0004 ). Conclusion There was no significant difference in both the short -term effect and complete remission rate between NACT + RS group and CCRT group on stage Ⅰ B2 - Ⅱ B locally advanced cervical cancer patients;it was significantly better on DFS and OS of NACT + RS group than that of CCRT group.