Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: A randomized study
Clinical efficacy of modified preoperative neoadjuvant chemotherapy in the treatment of locally advanced (stage IB2 to IIB) cervical cancer: A randomized study
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DOI：
10.1016/j.ygyno.2008.05.026
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发表时间：
2008-09-01
影响因子：
4.7
通讯作者：
Wu, Xufeng
中科院分区：
文献类型：
--
作者：
Chen, Huijun;Liang, Chuan;Wu, Xufeng
目标.术前新辅助化疗（NAC）在局部晚期宫颈癌（LACC）的使用受到阻碍的缺点是治疗无反应者的治疗延迟和放射抗性细胞的发展。然而，这些缺点可以通过在手术前短时间内施用的“快速”高剂量方案来克服。我们的目的是评估短周期、高封闭性药物NAC治疗LACC的疗效。从1999年至2004年，142例LACC患者（IB 2-IIB期，肿瘤直径≥ 4 Cm）被随机分配接受NAC后手术或直接手术。采用改良的NAC方案，周期短，药物剂量大。总临床有效率为69.4%。鳞癌和小于8 cm的肿瘤化疗效果较好（P=0.005，P=0.029）。病理结果显示，NAC组盆腔淋巴结转移率和宫旁浸润率明显低于初次手术组（P=0.025; P=0.038）。在接受NAC治疗的患者中，非NAC应答者的淋巴结转移率仍高达45.5%，而NAC应答者的淋巴结转移率降至16.0%（P=0.008）。同样的情况也发生在宫旁浸润：非NAC应答者为45.5%，而NAC应答者为16.0%（P=0.008）。生存分析显示，虽然对数秩检验显示NAC组的无瘤生存期长于初次手术组（P=0.041），但Coy风险分析未显示治疗方式是预后预测因素（P=0.074）。然而，进一步细分后，我们发现NAC应答者比非NAC应答者有更长的无瘤生存期和更低的复发率（P=0.000; P=0.013）。NAC反应也是独立的预后预测因子（P=0.005）。改良的术前NAC耐受性良好，有利于缩小肿瘤大小，消除病理风险因素，改善缓解者的预后。它还避免了对非NAC应答者的有效治疗的延迟。(C)2008年爱思唯尔公司All rights reserved.
Objectives. The use of preoperative neoadjuvant chemotherapy (NAC) in locally advanced cervical cancer (LACC) was hindered by the disadvantages of a delay of curative treatment for nonresponders and the development of radioresistant cells. However, these disadvantages may be overcome by a 'quick' high-dose scheme administered in a short period before surgery. Our purpose is to assess the efficacy of NAC with short cycle-length, high-close agents for LACC.Method. Froth 1999 to 2004, 142 of patients with LACC (stage IB2-IIB, tumor diameter >= 4 Cm) were assigned to randomly receive either NAC followed by surgery or primary surgery directly. A modified NAC scheme with short cycle-length, high-dose agents was used.Results. The overall clinical response rate was 69.4%. The chemotherapeutic response was more favorable in the squamous carcinoma and the tumors smaller than 8 cm (P=0.005, P=0.029). Pathologic findings showed that the pelvic lymph node metastasis and parametrial infiltration rates were significantly lower in NAC group than in the primary surgery group (P=0.025; P=0.038). Among patients who received NAC, the lymph node metastasis rate was still as high as 45.5% in non-NAC responders, and it decreased to 16.0% in NAC responders (P=0.008). The same thing also occurred with parametrial infiltration: 45.5% in non-NAC responders compared with 16.0% in NAC responders (P=0.008). Survival analysis revealed that although log-rank test showed a longer tumor-free survival in NAC group than in the primary surgery group (P=0.041), Coy hazard analysis did not indicate the therapy modality as a prognostic predictor (P=0.074). However, after further subdivision, we found that NAC responders had longer tumor-free survival and lower recurrence rate than non-NAC responders (P=0.000; P=0.013). NAC response was also an independent prognostic predictor (P=0.005).Conclusion. The modified preoperative NAC is swell tolerated and beneficial in reducing tumor size, eliminating pathological risk factors, and improving prognosis for responders. It also avoids the delay of effective treatment for non-NAC responders. (C) 2008 Elsevier Inc. All rights reserved.