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目的探讨新辅助化疗在宫颈癌治疗中的应用价值。方法自1991年1月起山东省肿瘤医院开始进行放疗前新辅助化疗的临床前瞻性研究,选择1991年1月—2003年12月符合入组标准的宫颈癌患者共1609例,放疗前给予2个疗程联合化疗(A组);另选择1989年1月—1990年12月接受单纯放疗的375例宫颈癌患者作对照(B组)。比较两组患者的近期控制情况、长期生存率及并发症的发生情况。结果A组化疗2个疗程后总有效率为74.5%(1199/1609),局部完全缓解率为1.6%(25/1609)。A组的3、5、10年生存率分别为90.3%(1017/1126)、75.3%(652/866)、59.0%(200/339),其中临床分期Ⅱ期患者的5年生存率显著高于Ⅲ期者(P<0.05);而两者的3、10年生存率相近(P>0.05)。B组的3、5、10年生存率分别为81.1%(304/375)、59.2%(222/375)、40.3%(151/375),其中Ⅱ期患者的5、10年生存率均显著高于Ⅲ期者(P<0.05)。A、B两组间5、10年生存率比较,差异均有统计学意义(P<0.05)。A组宫颈腺癌患者的3、5、10年生存率均显著高于B组(P<0.05),且A组Ⅲ期患者的3、5年复发率及转移率明显低于B组(P<0.05);A组化疗后的毒副反应主要为轻、中度消化道反应和骨髓抑制,经处理后均能恢复,其近期、远期放疗并发症发生率和B组比较,差异无统计学意义(P>0.05)。结论新辅助化疗对宫颈癌的治疗是安全有效的,能明显提高患者的近期疗效和长期生存率,特别是对于宫颈腺癌及临床晚期患者效果尤为显著。
Objective To investigate the value of neoadjuvant chemotherapy in the treatment of cervical cancer. Methods Since January 1991, Shandong Cancer Hospital started a prospective clinical study of neoadjuvant chemotherapy before radiotherapy. A total of 1,609 cervical cancer patients who met the inclusion criteria from January 1991 to December 2003 were selected and given 2 (A group). Another 375 cervical cancer patients who underwent radiotherapy alone from January 1989 to December 1990 were selected as control group (B). The recent control, long-term survival and complication of the two groups were compared. Results The total effective rate was 74.5% (1199/1609) after 2 courses of chemotherapy in group A, and 1.6% (25/1609) in partial response rate. The 3-year, 5-year and 10-year survival rates in group A were 90.3% (1017/1126), 75.3% (652/866) and 59.0% (200/339), respectively. (P <0.05), while the 3- and 10-year survival rates of the two groups were similar (P> 0.05). The 3, 5 and 10-year survival rates in group B were 81.1% (304/375), 59.2% (222/375) and 40.3% (151/375), respectively. The 5-year and 10-year survival rates were significantly higher in group B Higher than those in stage Ⅲ (P <0.05). The 5-year and 10-year survival rates of A and B groups were significantly different (P <0.05). The 3-year, 5-year and 10-year survival rates of patients with cervical adenocarcinoma in group A were significantly higher than those in group B (P <0.05), and the recurrence rates and metastasis rates at 3 and 5 years in group A were significantly lower than those in group B <0.05). The side effects after chemotherapy in group A were mainly mild and moderate gastrointestinal reactions and bone marrow suppression, which could be recovered after treatment. The incidence of long-term radiotherapy and complications in group A was no statistical difference Significance (P> 0.05). Conclusion Neoadjuvant chemotherapy is safe and effective for the treatment of cervical cancer, which can significantly improve the short-term efficacy and long-term survival rate of patients, especially for cervical adenocarcinoma and advanced clinical patients.