The Long-Term Efficacy of Neoadjuvant Chemotherapy Followed by Radical Hysterectomy Compared With Radical Surgery Alone or Concurrent Chemoradiotherapy on Locally Advanced-Stage Cervical Cancer
The Long-Term Efficacy of Neoadjuvant Chemotherapy Followed by Radical Hysterectomy Compared With Radical Surgery Alone or Concurrent Chemoradiotherapy on Locally Advanced-Stage Cervical Cancer
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DOI：
10.1111/igc.0b013e3181fe8b6e
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发表时间：
2011-01-01
影响因子：
4.8
通讯作者：
Chen, Xiuwei
中科院分区：
文献类型：
--
作者：
Yin, Mingzhu;Zhao, Falin;Chen, Xiuwei
目的：本研究的目的是比较局部晚期宫颈癌患者的长期生存率（IB 2-IIB期）接受新辅助化疗，随后行根治性子宫切除术（子宫切除加盆腔淋巴结清扫）（NACT + RS）与接受根治性手术治疗的患者的生存率方法：回顾性分析2002年1月至2003年12月间我院收治的120例盆腔淋巴结转移患者的临床资料。随访时间54 ~ 114个月（中位82.8个月）。结果：2000年1月至2005年12月，对476例符合条件的患者进行了随访。NACT + RS、RS和CCRT组的5年DFS率分别为85.00%、77.44%和52.94%（P < 0.0001），而5年OS率分别为88.67%、80.21%和64.37%（P < 0.0001）。NACT + RS组的生存率显著高于RS组和NACT + RS组。（DFS：风险比= 1.870，P = 0.0031; OS：风险比= 1.813，P = 0.0175）和CCRT 0001; 0 S：风险比= 3.157，P < 0.0001）组，同时校正病理类型、临床分期、肿瘤大小（初始）和年龄。接受TP（紫杉醇和顺铂）治疗的患者的5年DFS率为90.55%，接受PVB（顺铂、长春新碱和博莱霉素）治疗的患者的5年DFS率为71.70%; TP和PVB的5年OS率分别为96.75%和70.09%。TP组患者5年无病生存率和总生存率均有统计学显著改善（P < 0.001）。结论：与单纯RS相比，新辅助化疗联合RS能改善IB 2-IIB期局部晚期宫颈癌患者的长期无病生存率和总生存率，尤其是与CCRT相比。在NACT + RS组中，与PVB化疗方案相比，NACT + TP改善了患者的长期DFS和OS。这些结果可能为临床医生治疗局部晚期宫颈癌患者提供一些有用的信息。
Objectives: The purpose of this study was to compare the long-term survival of patients with locally advanced cervical cancer (stages IB2-IIB) treated with neoadjuvant chemotherapy followed by radical hysterectomy (hysterectomy plus pelvic lymph node dissection) (NACT + RS) with the survival of those treated with radical surgery (hysterectomy plus pelvic lymph node dissection) (RS) or concurrent chemoradiotherapy (CCRT).Methods: A retrospective study was performed. Patients were followed up for 54 to 114 months (median, 82.8 months). All risk factors that may have affected the disease-free survival (DFS) and overall survival (OS) were assessed.Results: From January 2000 to December 2005, 476 eligible patients were followed up. The 5-year DFS rates of the NACT + RS, RS, and CCRT groups were 85.00%, 77.44%, and 52.94%, respectively (P < 0.0001), whereas the 5-year OS rates were 88.67%, 80.21% and 64.37%, respectively (P < 0.0001). The NACT + RS group had significantly higher survival rates than both the RS (DFS: hazard ratio = 1.870, P = 0.0031; OS: hazard ratio = 1.813, P = 0.0175) and CCRT (DFS: hazard ratio = 3.535, P G 0.0001; OS: hazard ratio = 3.157, P < 0.0001) groups, while adjusting for the pathological type, clinical stage, tumor size (initial), and age. The 5-year DFS rate for patients receiving TP (paclitaxel and cisplatin) was 90.55%, and 71.70% for patients receiving PVB (cisplatin, vincristine, and bleomycin); the 5-year OS rates were 96.75% for TP and 70.09% for PVB, respectively. Patients receiving TP had a statistically significant improvement in both 5-year DFS and OS rates (P < 0.001).Conclusions: Neoadjuvant NACT + RS improves the long-term DFS and OS of patients with locally advanced cervical cancer stage IB2-IIB compared with RS alone and especially compared with CCRT. In the NACT + RS group, NACT with TP improves the long-term DFS and OS of patients compared with patients who had PVB chemotherapy regimen. These results may provide some useful information for clinicians to treat patients with locally advanced cervical carcinoma.