Department of Obstetrics and Gynecology, West China Second Hospital, West China Center of Medical Sciences, Sichuan University, Chengdu, China.
Int J Gynaecol Obstet. 2012 Apr;117(1):23-6. doi: 10.1016/j.ijgo.2011.11.017. Epub 2012 Jan 21.
To evaluate clinical efficacy, toxicity, and survival outcomes of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) among patients with cervical cancer stage IB2-IIB.
In a retrospective clinical study at West China Second Hospital, Chengdu, data were analyzed from 414 patients who underwent NACT followed by radical surgery (NACT-RS) or RS alone between January 2008 and November 2009.
The clinical response for NACT was 90%. Lymph node metastasis (25% versus 48%, P<0.05) and deep cervical stromal invasion more than 0.5, (68% versus 91%, P<0.05) were significantly lower among responders than among non-responders, respectively, in the NACT-RS group. The 2-year progression-free survival and 2-year overall survival were 93.0% and 95.5% in the NACT-RS group, and 94.5% and 97.1% in the RS group (P>0.05). Parametric infiltration (hazard ratio [HR], 7.668; P<0.05) and lymph node metastasis (HR, 7.714; P<0.05) were independent risk factors for all study patients.
Compared with RS, NACT-RS did not show a significant advantage for patients with locally advanced cervical cancer. However, the data provide the rationale for assessing NACT-RS in a multicenter randomized clinical trial setting. NACT may be considered as an alternative treatment when radiotherapy is not available.
评估新辅助化疗（NACT）后行根治性手术（RS）与单纯 RS 治疗宫颈癌 IB2 期至 IIB 期患者的临床疗效、毒性和生存结局。
本回顾性临床研究在成都华西第二医院进行，分析了 2008 年 1 月至 2009 年 11 月期间接受 NACT 后行根治性手术（NACT-RS）或单纯 RS 的 414 例患者的数据。
NACT 的临床缓解率为 90%。在 NACT-RS 组中，与无反应者相比，反应者的淋巴结转移（25%对 48%，P<0.05）和深宫颈间质浸润>0.5（68%对 91%，P<0.05）的比例显著降低。NACT-RS 组的 2 年无进展生存率和总生存率分别为 93.0%和 95.5%，RS 组分别为 94.5%和 97.1%（P>0.05）。参数浸润（风险比 [HR]，7.668；P<0.05）和淋巴结转移（HR，7.714；P<0.05）是所有研究患者的独立危险因素。
与 RS 相比，NACT-RS 对局部晚期宫颈癌患者并未显示出显著优势。然而，这些数据为在多中心随机临床试验中评估 NACT-RS 提供了依据。当放疗不可用时，NACT 可被视为一种替代治疗方法。
