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[目的]探讨新辅助化疗在Ⅰb～Ⅲb期宫颈癌术前辅助治疗中的临床效果。[方法]选择2005年1月~2007年1月荆门市第二人民医院收治的68例Ⅰb～Ⅲb期宫颈癌患者,36例新辅助化疗,其中24例采用静脉化疗,12例采用动脉化疗;32例直接手术,设为对照组,比较两组的疗效、患者术中出血量、宫旁浸润率、阴道切缘阳性率、淋巴结转移率及并发症的差异。对患者进行随访,分析新辅助化疗对远期预后的影响。[结果]NACT组完全缓解5例,部分缓解26例,总有效率达86.1%;Ⅰb~Ⅱb期的有效率(87.1%)明显高于Ⅲa-Ⅲb期(60%);术中出血量NACT组显著少于对照组(P﹤0.05);NACT组淋巴结转移率(36.1%)低于对照组(50.0%)两者比较,差异有统计学意义(P﹤0.05)。两组的宫旁浸润率分别为2.7%和15.6%,经精确概率法计算,两者比较,差异有统计学意义(P﹤0.05)。NACT组与对照组的1年无瘤生存率分别为78.16%和80.02%,1年总生存率分别为94.05%和95.87%,差异无统计学意义(P﹥0.05)。[结论]新辅助化疗对局部晚期宫颈癌患者近期疗效显著,可明显减少术后宫旁浸润,淋巴结转移,降低术后并发症。
[Objective] To investigate the clinical effect of neoadjuvant chemotherapy in preoperative adjuvant treatment of stage Ⅰb ~ Ⅲb cervical cancer. [Methods] Sixty-eight patients with stage Ⅰb-Ⅲb cervical cancer admitted to Jingmen Second People’s Hospital from January 2005 to January 2007 were enrolled in this study. Thirty-six neoadjuvant chemotherapies were enrolled. Among them, 24 patients received intravenous chemotherapy and 12 patients received arterial chemotherapy. Thirty-two patients underwent direct surgery. The control group was divided into two groups: the curative effect, intraoperative blood loss, parametrial infiltration rate, positive vaginal margin, lymph node metastasis rate and complications. The patients were followed up to analyze the impact of neoadjuvant chemotherapy on long-term prognosis. [Results] In the NACT group, complete remission in 5 cases and partial remission in 26 cases resulted in a total effective rate of 86.1%. The effective rate (87.1%) in stage Ⅰb-Ⅱb was significantly higher than that in stage Ⅲa-Ⅲb (60%); (P <0.05). The rate of lymph node metastasis in NACT group (36.1%) was lower than that in control group (50.0%), the difference was statistically significant (P <0.05). The paracancerous infiltration rates of the two groups were 2.7% and 15.6%, respectively. Comparing the two methods, the difference was statistically significant (P <0.05). The one-year disease-free survival rates of NACT group and control group were 78.16% and 80.02%, respectively, and the 1-year overall survival rates were 94.05% and 95.87% respectively, with no significant difference (P> 0.05). [Conclusion] Neoadjuvant chemotherapy has a significant short-term curative effect on patients with locally advanced cervical cancer, which can significantly reduce postoperative uterine infiltration and lymph node metastasis and reduce postoperative complications.