[新辅助化疗和术前放疗后宫颈癌患者（IB2-IVA期）术后标本的组织病理学发现]

[Histopathological findings in postoperative specimens in cervical cancer patients (IB2-IVA) after neoadjuvant chemotherapy and preoperative radiotherapy].

作者信息

Kornovski Ia, Gorchev G

出版信息

Akush Ginekol (Sofiia). 2007;46(1):28-34.

Abstract

OBJECTIVES

To determine the incidence rate of the histopathological findings indicative of recurrence risk in patients with locally advanced cervical cancer (LACC) having been treated with neoadjuvant chemotherapy (NCT) and radiation therapy (RT) before operation.

MATERIALS AND METHODS

Sixty-three patients were included, of whom 45 patients (group 1) underwent a percutaneous TGT and surgical treatment, and 18 patients were treated with NCT and surgery (group 2). The surgical treatment was class Ill-V radical hysterectomy with pelvic lymph node dissection, and paraaortic lymph node dissection at indication. NCT included a triple cytostatic combination - cisplatin, holoxan and bleomycin delivered in 3 courses at intervals of 21 days. In group 1, 13 patients were staged IB2 (28,9%), 29 were staged I/B (64,4%), 2 were staged 11B (4,4%), and 1 was staged IVA (2,2). Forty-four patients had a squamous cell carcinoma (97,8%) and 1 had adenocarcinoma (2,2%). In group 2, 13 patients were staged IIB (72,2%), 4 were staged 11B (22,25) and 1 was staged IVA (5,6%), whereas all 18 patients had a squamous cell carcinoma (100%). The average age in group 1 and 2 was 48,8 (range from 31 to 69 years) and 46,3 ( range from 32 to 64 years) respectively.

RESULTS

In group 2 (NCT + surgical treatment) lymph node metastases (LM) were found in 38,89%, macroscopic detectable metastases in 22%, multiple (>3 LM) in 17%, LM above the a. aliaca comm. level in 22%, deep stromal invasion in 47%, parametral infiltration in 24%,lymphovascular space invasion (LVSI) in 12%, tumor infiltration in canalis cervicalis (CC) in 12%, and ovarian metastases in 6%. In group 1 (RT + surgical treatment) we found LM in 35,56%, macroscopic detectable LM in 15,6%, LM above the a.iliaca comm. level - 11, 1%, multiple LM in 17,8%, parametral invasion in 4,4%, deep stromal invasion in 31,1%, LVSI - 13,3%, infiltration in can.cerv. - 15,6%, infiltration in isthmus uteri- 8,9% and ovarian metastases - 4,4%.

CONCLUSION

NCT followed by surgical treatment leads to histological results in the postoperative specimen that are not worse than the standard preoperative RT

摘要

目的

确定接受新辅助化疗（NCT）和术前放射治疗（RT）的局部晚期宫颈癌（LACC）患者中提示复发风险的组织病理学结果的发生率。

材料与方法

纳入63例患者，其中45例患者（第1组）接受了经皮TGT和手术治疗，18例患者接受了NCT和手术治疗（第2组）。手术治疗为III-V类根治性子宫切除术加盆腔淋巴结清扫术，必要时行腹主动脉旁淋巴结清扫术。NCT包括三种细胞抑制剂联合使用——顺铂、环磷酰胺和博来霉素，分3个疗程给药，间隔21天。在第1组中，13例患者为IB2期（28.9%），29例为IIB期（64.4%），2例为IIB期（4.4%），1例为IVA期（2.2%）。44例患者为鳞状细胞癌（97.8%），1例为腺癌（2.2%）。在第2组中，13例患者为IIB期（72.2%），4例为IIB期（22.2%），1例为IVA期（5.6%），而所有18例患者均为鳞状细胞癌（100%）。第1组和第2组的平均年龄分别为48.8岁（范围31至69岁）和46.3岁（范围32至64岁）。

结果

在第2组（NCT+手术治疗）中，发现淋巴结转移（LM）的比例为38.89%，宏观可检测转移的比例为22%，多发（>3个LM）的比例为17%，髂总动脉水平以上的LM比例为22%，深部基质浸润的比例为47%，宫旁浸润的比例为24%，淋巴管间隙浸润（LVSI）的比例为12%，宫颈管肿瘤浸润（CC）的比例为12%，卵巢转移的比例为6%。在第1组（RT+手术治疗）中，我们发现LM的比例为35.56%，宏观可检测的LM比例为15.6%，髂总动脉水平以上的LM比例为11.1%，多发LM比例为17.8%，宫旁浸润比例为4.4%，深部基质浸润比例为31.1%，LVSI比例为13.3%，宫颈管浸润比例为15.6%，子宫峡部浸润比例为8.9%，卵巢转移比例为4.4%。