Wang Peng-Hui, Chang Yen-Hou, Yang Ying-Hui, Chang Wen-Hsun, Huang Shu-Yun, Lai Chiung-Ru, Juang Chi-Mou, Chen Yi-Jen, Horng Huann-Cheng, Wen Kuo-Chang, Ng Heung-Tat, Yuan Chiou-Chung, Chao Kuan-Chong, Yen Ming-Shyen
Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Nursing, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2014 Sep;53(3):330-6. doi: 10.1016/j.tjog.2014.05.001.
To study the surgical morbidity and outcomes of patients with markedly bulky cervical squamous cell carcinoma (≥ 6 cm Cx-SCC) who underwent radical hysterectomy (RH) with and without neoadjuvant chemotherapy (NACT).
This retrospective study enrolled patients with International Federation of Gynecology and Obstetrics (FIGO) IB markedly bulky Cx-SCC who were treated with either three courses of weekly single agent cisplatin NACT (50 mg/m2) and subsequent radical hysterectomy (NACT-RH) or direct radical hysterectomy (RH) between 1996 and 2001. A total of 60 patients fulfilled the criteria, including 35 and 25 patients with NsACT-RH and RH, respectively.
There was no statistically significant difference in basic characteristics between the two groups, except the smaller pathological tumor size, less blood loss, and lower immediate complication rate in the NACT-RH group. Median survival was 143.8 months in the NACT-RH group and 129.8 months in the RH group, respectively, without a statistically significant difference. Multivariate analysis showed that large pathological tumor size [hazard ratio (HR) 10.66, 95% confidence interval (CI) 2.93-38.80], the presence of para-aortic lymph node metastases and an immediate complication (HR 8.33 and 4.55, 95% CI 1.66-41.75 and 1.35-15.27, respectively) contributed to a worse outcome.
Weekly single agent cisplatin NACT indeed reduced the pathological tumor size and immediate complication rate during the RH, supporting the feasibility of subsequent RH in the management of patients with bulky Cx-SCC.
研究接受或未接受新辅助化疗（NACT）的根治性子宫切除术（RH）治疗的显著巨大宫颈鳞状细胞癌（≥6 cm宫颈鳞状细胞癌）患者的手术发病率及预后。
本回顾性研究纳入了1996年至2001年间国际妇产科联盟（FIGO）IB期显著巨大宫颈鳞状细胞癌患者，这些患者接受了三个疗程的每周单药顺铂NACT（50 mg/m²）及随后的根治性子宫切除术（NACT-RH）或直接根治性子宫切除术（RH）。共有60例患者符合标准，其中NACT-RH组35例，RH组25例。
两组患者的基本特征无统计学显著差异，但NACT-RH组病理肿瘤尺寸较小、失血较少且近期并发症发生率较低。NACT-RH组和RH组的中位生存期分别为143.8个月和129.8个月，无统计学显著差异。多因素分析显示，病理肿瘤尺寸大[风险比（HR）10.66，95%置信区间（CI）2.93 - 38.80]、腹主动脉旁淋巴结转移及近期并发症（HR分别为8.33和4.55，95% CI分别为1.66 - 41.75和1.35 - 15.27）会导致预后较差。
每周单药顺铂NACT确实减小了RH期间的病理肿瘤尺寸并降低了近期并发症发生率，支持在巨大宫颈鳞状细胞癌患者管理中后续进行RH的可行性。
