Liu Shi-Ping, Yang Jia-Xin, Cao Dong-Yan, Shen Keng, Xiang Yang, Lang Jing-He
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China.
Mol Clin Oncol. 2014 Mar;2(2):240-244. doi: 10.3892/mco.2013.227. Epub 2013 Dec 18.
Cervical cancer is currently the first or second leading cause of cancer-related mortality among women in developing countries. This study was conducted in order to determine whether neoadjuvant cisplatin and 5-flourouracil (NAPF) prior to surgery is superior to primary surgical treatment (PST) as a treatment option for patients with International Federation of Gynaecology and Obstetrics (FIGO) stage IB2/IIA2 cervical cancer. A retrospective review of 195 patients with early-stage bulky cervical cancer was performed. The patients were divided into two groups, according to whether they received NAPF prior to surgery. The surgical profiles and complications, risk factors of recurrence and survival were compared between the groups. The response rate to NAPF was found to be 61.2%. There were no differences in operative time and intra-operative complications between the two groups, whereas the estimated blood loss in the NAPF and PST groups were 620.1±394.9 and 434.8±233.7 ml, respectively (P=0.000). When compared with PST, NAPF remarkably reduced tumor size (22.5 vs. 93.3%, P=0.000). Furthemore, the ratio of deep stromal invasion was significantly lower in responders to NAPF compared with that in non-responders (46.7 vs. 76.3%, respectively; P=0.004) and in the PST group (46.7 vs. 70.0%, respectively; P=0.004). No reduction of high-risk factors (HRFs) was observed. The NAPF group, even the responder subgroup, exhibited no significant improvement in progression-free survival (PFS) and overall survival (OS) compared to the PST group. In conclusion, despite the reduction of intermediate-risk factors (IRFs), neoadjuvant chemotherapy (NAC) with the NAPF regimen prior to radical surgery (RS) did not improve the prognosis in patients with FIGO stage IB2/IIA2 cervical cancer.
宫颈癌目前是发展中国家女性癌症相关死亡的首要或第二大原因。本研究旨在确定术前新辅助顺铂和5-氟尿嘧啶（NAPF）作为国际妇产科联盟（FIGO）IB2/IIA2期宫颈癌患者的一种治疗选择是否优于原发性手术治疗（PST）。对195例早期巨大宫颈癌患者进行了回顾性研究。根据患者术前是否接受NAPF将其分为两组。比较两组的手术情况、并发症、复发风险因素和生存率。发现NAPF的有效率为61.2%。两组的手术时间和术中并发症无差异，而NAPF组和PST组的估计失血量分别为620.1±394.9和434.8±233.7 ml（P=0.000）。与PST相比，NAPF显著减小了肿瘤大小（22.5%对93.3%，P=0.000）。此外，与无反应者相比，NAPF反应者的深层间质浸润率显著更低（分别为46.7%对76.3%；P=0.004），与PST组相比也更低（分别为46.7%对70.0%；P=0.004）。未观察到高危因素（HRFs）减少。与PST组相比，NAPF组，即使是反应者亚组，在无进展生存期（PFS）和总生存期（OS）方面也未显示出显著改善。总之，尽管降低了中度风险因素（IRFs），但在根治性手术（RS）前采用NAPF方案进行新辅助化疗（NAC）并未改善FIGO IB2/IIA2期宫颈癌患者的预后。
