Yoshino Kiyoshi, Hosoi Ayako, Osuga Keigo, Enomoto Takayuki, Ueda Yutaka, Sawada Kenjiro, Mabuchi Seiji, Kobayashi Eiji, Matsuo Koji, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Mol Clin Oncol. 2016 Jun;4(6):1068-1072. doi: 10.3892/mco.2016.846. Epub 2016 Apr 4.
Extended wait time prior to initial surgery may increase patients' anxiety. Therefore, patients may opt to receive other available treatments to inhibit tumor growth until surgery. This retrospective study describes our experience with single-dose intra-arterial neoadjuvant chemotherapy (IANAC) to more effectively utilize the wait time prior to radical hysterectomy. A total of 12 patients with International Federation of Gynecology and Obstetrics stage IB1-IIB cervical cancer were treated with single-dose IANAC prior to radical hysterectomy. Cisplatin and paclitaxel were administered intra-arterially or intravenously, respectively. The surgical outcome, prognosis and factors affecting disease recurrence were compared between these 12 patients and 57 patients in a primary surgery alone (PS) control group. As regards surgical outcome, there were no significant differences between the two groups. During the postoperative follow-up period (median, 41 months), disease recurrence was observed in 5/12 (41.6%) IANAC cases and in 22/57 (38.5%) PS cases (median follow-up, 54 months). There was no significant difference in disease-free survival (DFS) or 3-year survival rates between IANAC and PS (91.6 vs. 71.9%, respectively). The multivariate analysis demonstrated that wait time duration (≥45 vs. <45 days) and the use of IANAC did not affect DFS. Only tumor histology (squamous vs. non-squamous) was found to be an independent prognostic factor for DFS (hazard ratio = 0.35, 95% confidence inerval: 0.145-0.8967, P=0.0292). In addition, distal recurrence was statistically more frequent in the IANAC group compared with that in the PS group (P=0.0405). Therefore, single-cycle IANAC should not be performed without careful consideration.
初次手术前延长等待时间可能会增加患者的焦虑情绪。因此，患者可能会选择接受其他可用治疗以抑制肿瘤生长，直至手术。这项回顾性研究描述了我们使用单剂量动脉内新辅助化疗（IANAC）的经验，以便更有效地利用根治性子宫切除术之前的等待时间。共有12例国际妇产科联盟（FIGO）分期为IB1-IIB期的宫颈癌患者在根治性子宫切除术前行单剂量IANAC治疗。顺铂和紫杉醇分别通过动脉内或静脉内给药。将这12例患者与57例仅接受初次手术（PS）的对照组患者在手术结果、预后及影响疾病复发的因素方面进行比较。在手术结果方面，两组之间无显著差异。在术后随访期（中位时间为41个月），IANAC组12例中有5例（41.6%）出现疾病复发，PS组57例中有22例（38.5%）出现疾病复发（中位随访时间为54个月）。IANAC组和PS组的无病生存率（DFS）或3年生存率无显著差异（分别为91.6%和71.9%）。多因素分析表明，等待时间（≥45天与<45天）和IANAC的使用并不影响DFS。仅发现肿瘤组织学类型（鳞状与非鳞状）是DFS的独立预后因素（风险比=0.35，95%置信区间：0.145-0.8967，P=0.0292）。此外，IANAC组的远处复发在统计学上比PS组更常见（P=0.0405）。因此，不应在未经仔细考虑的情况下进行单周期IANAC治疗。
