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目的探讨新辅助化疗(neoadjuvant chemotherapy,NACT)对早期巨块型宫颈癌淋巴结转移及生存的意义。方法回顾性分析165例Ⅰb2～Ⅱa期巨块型宫颈癌患者的病例资料并进行随访,根据术前是否行化疗分为NACT组(n=68)和直接手术组(n=97),比较2组淋巴结转移率及生存情况。结果 NACT及直接手术组发生淋巴结转移的患者转移率差异无统计学意义(13.2%vs 16.5%,P=0.565);但化疗应答者淋巴结转移率则明显低于无应答者(4.8%vs26.9%,P=0.031)。按阳性淋巴结数目计算,NACT组盆腔淋巴结转移率亦低于直接手术组(1.2%vs 2.8%,P=0.002)。截至随访时间止,淋巴结阳性者5年生存率低于淋巴结阴性者(63.0%vs 86.0%,P=0.252)。NACT组5年生存率高于直接手术组(91.0%vs 77.0%,P=0.274)。对化疗应答者5年生存率高于直接手术组(93.0%vs 87.0%,P=0.145)。结论新辅助化疗可以控制宫颈癌淋巴结受累,但对5年生存率及总生存率的影响尚未显示出明显优势。
Objective To investigate the significance of neoadjuvant chemotherapy (NACT) in lymph node metastasis and survival of early giant cervical carcinoma. Methods A retrospective analysis of 165 patients with stage Ⅰb2 ~ Ⅱa massive cervical cancer patients was followed up, according to whether the preoperative chemotherapy was divided into NACT group (n = 68) and direct surgery group (n = 97), compared with 2 Group lymph node metastasis rate and survival. Results There was no significant difference in the metastasis rate between patients with NACT and those with direct surgery (13.2% vs 16.5%, P = 0.565). However, the rates of lymph node metastasis were significantly lower in non-responders (4.8% vs 26.9% %, P = 0.031). According to the number of positive lymph nodes, the pelvic lymph node metastasis rate in NACT group was also lower than that in direct surgery group (1.2% vs 2.8%, P = 0.002). As of follow-up, the 5-year survival of lymph node-positive patients was lower than that of lymph node-negative patients (63.0% vs 86.0%, P = 0.252). The 5-year survival rate of NACT group was higher than that of direct surgery group (91.0% vs 77.0%, P = 0.274). The 5-year survival rates of chemotherapy responders were higher than those of the direct surgery group (93.0% vs 87.0%, P = 0.145). Conclusion Neoadjuvant chemotherapy can control cervical lymph node involvement, but the 5-year survival rate and overall survival rate has not shown any obvious advantage.