新辅助化疗治疗宫颈癌的临床病例对照研究

发布时间：2018-05-29 16:09

本文选题：宫颈癌 + 新辅助化疗　；参考：《郑州大学》2016年硕士论文

【摘要】：背景宫颈癌是一种常见恶性肿瘤,其发病率居妇科恶性肿瘤第二,仅次于乳腺癌。近年来宫颈癌发病率呈逐年上升趋势,宫颈癌患者年轻化趋势明显。为应对宫颈癌发病的新趋势,新辅助化疗(NACT)被逐渐的认可和推广应用。新辅助化疗(NACT)可实现缩小病灶体积和范围、改善宫旁浸润状况、改善手术情况,提高对肿瘤病灶的手术切除率,及病灶在放射治疗阶段对放射治疗的敏感性;同时还可使微转移病灶得到清除或有效的抑制。TP方案作为新辅助化疗方案的一种,其临床用药不断升级出新。作为铂类和紫杉醇类的升级药物,力朴素、多西他赛、奥沙利铂等在临床上得以逐渐推广应用。目的对比、探讨在宫颈癌新辅助化疗阶段,力朴素与奥沙利铂组合、多西他赛与奥沙利铂组合的TP方案的疗效及化疗副反应。方法选取2012年9月至2015年12月郑州大学人民医院收治的117例宫颈癌患者为研究对象。参照FIGO标准临床分析分为Ⅰb2、Ⅱa2期。其中35例Ⅰb2、Ⅱa2期患者列为对照组A组,该组经过术前常规检查,直接实施广泛性子宫切除术+盆腔淋巴结清扫术;82例Ⅰb2、Ⅱa2期患者列为实验组,该组先行实施新辅助化疗两个疗程,再行广泛性子宫切除术+盆腔淋巴结清扫术;实验组又分为TP1、TP2组,各41例,TP1组实施力朴素与奥沙利铂组合的新辅助化疗;TP2组实施多西他赛与奥沙利铂组合的新辅助化疗。比较对照组、实验组手术情况、术后并发症和术后病理状况。比较TP1组、TP2组间化疗有效性、化疗毒副作用;化疗后手术情况、术后并发症和术后病理状况。结果实验组、对照组患者的年龄分布、病理类型、病灶组织学分级均无统计学差异,P0.05。实验组82例患者,化疗总有效率(CR+PR)96.3%;TP1组41例患者,化疗有效率(CR+PR)97.6%,TP2组41例患者,化疗有效率(CR+PR)95.2%,TP1、TP2组间化疗有效率无统计学差异,P0.05。实验组82例患者,鳞癌78例、腺癌4例,鳞癌化疗总有效率97%,腺癌化疗总有效率75%;病理类型不同,化疗有效率差异有统计学意义,P0.05。实验组82例患者经过2个疗程的化疗后,出现化疗毒副作用表征的71例,主要表现为胃肠道副作用和血液学毒性副作用,并且毒副作用程度较轻微;TP1、TP2组间血液学毒性反应:白细胞及中性粒细胞减少,两组间有统计学差异,P0.05;血红蛋白减少两组间比较无统计学差异,P0.05。实施根治性手术时,实验组、对照组的手术时间和淋巴结切除数无统计学差异,P0.05;但术中出血量有统计学差异,P0.05。本次研究术后并发症发生36例,其中对照组术后并发症13例(37.1%),实验组23例(28.1%),两组术后并发症无显著差异,P0.05;TP1和TP2组间比较,针对感染、术后血栓及其他等情况各组间无显著统计学差异,P0.05;针对淋巴囊肿和尿潴留并发症存在统计学差异,P0.05。实验组与对照组间、实验组内TP1、TP2组间对阴道切缘阳性率无统计学差异,P0.05;淋巴结转移、脉管浸润阳性率差异有统计学差异,P0.05。结论应用力朴素与奥沙利铂组合、多西他赛与奥沙利铂组合的新辅助化疗临床应用可行,疗效明显;并且在后续实施根治性手术治疗时,出血量少,术后并发症少,值得临床推荐应用。力朴素与奥沙利铂组合、多西他赛与奥沙利铂组合用药方案化疗整体有效率接近,但相较多西他赛与奥沙利铂组合的化疗方案,力朴素与奥沙利铂组合化疗后毒副作用低;手术情况更好;术后淋巴结、尿潴留并发症出现的几率更低;阴道切缘阳性率、淋巴结转移、脉管浸润阳性率等病理性反应更低。
[Abstract]:Background cervical cancer is a common malignant tumor, the incidence of which is second of gynecologic malignant tumor, second only to breast cancer. In recent years, the incidence of cervical cancer is increasing year by year, and the trend of the young of cervical cancer patients is obvious. In order to cope with the new trend of cervical cancer, new adjuvant chemotherapy (NACT) has been gradually approved and popularized. New adjuvant chemotherapy (NAC T) can reduce the size and scope of the lesion, improve the status of the paravatal infiltration, improve the operation, improve the resection rate of the tumor, and the sensitivity of the lesion to the radiotherapy at the stage of radiation therapy. At the same time, the micrometastases can be removed or effectively suppressed by the.TP regimen as a new adjuvant chemotherapy scheme. As an upgrading drug of platinum and paclitaxel, it is gradually popularized as an upgrade drug for platinum and taxol, docetaxel and oxaliplatin. Objective to compare the efficacy and side effects of the TP regimen in the new adjuvant chemotherapy stage of cervical cancer, the combination of Austin and oxaliplatin, and the combination of docetaxel and oxaliplatin. 117 cases of cervical cancer treated in the people's Hospital of Zhengzhou University from September 2012 to December 2015 were studied. According to the clinical analysis of FIGO standard, the clinical analysis was divided into I B2 and II A2 stage. 35 of them were I B2, and the patients of stage II A2 were listed as the control group A. The group underwent routine examination before operation, and the extensive hysterectomy plus pelvic lymph node dissection; 8 2 cases of I B2 and stage II A2 were listed as the experimental group. The group was given two courses of neoadjuvant chemotherapy, and then extensive hysterectomy and pelvic lymph node dissection. The experimental group was divided into TP1, group TP2, 41 cases, and group TP1 to carry out new adjuvant chemotherapy with the combination of austere and oxaliplatin, and group TP2 to carry out the new adjuvant of the combination of docetaxel and oxaliplatin in the group TP2 Chemotherapy, compared with the control group, the operation situation, postoperative complications and postoperative pathological conditions in the experimental group, compared with group TP1, group TP2, chemotherapy and side effects, postoperative operation, postoperative complications and postoperative pathological conditions. Results of the experimental group and the control group, the age distribution, pathological type, and histological classification of the focus were not statistically poor. P0.05. experimental group 82 patients, chemotherapy total efficiency (CR+PR) 96.3%, TP1 group 41 patients, chemotherapy efficiency (CR+PR) 97.6%, TP2 group 41 patients, chemotherapy effective (CR+PR) 95.2%, TP1, TP2 group effectiveness rate of no statistically significant difference, P0.05. experimental group 82 patients, squamous carcinoma 78 cases, adenocarcinoma 4 cases, squamous cancer chemotherapy total efficiency 97%, adenocarcinoma chemotherapy is always The efficiency was 75%, the pathological type was different, the difference of the effective rate of chemotherapy was statistically significant. After 2 courses of chemotherapy, 82 patients in the P0.05. experimental group had 71 cases of toxic and side effects of chemotherapy. The main manifestations were the side effects of the gastrointestinal tract and the side effects of Hematology, and the toxic side effects were mild; the hematological toxicity reaction between group TP2 and group TP1: white thin. Cell and neutrophils decreased, there was a statistical difference between the two groups, P0.05, and there was no statistical difference between the two groups. There was no statistical difference between the operation time and the number of lymph nodes in the control group when the radical operation was performed by P0.05., P0.05. However, there was a statistical difference in the amount of blood in the operation, and P0.05. was this time to study the postoperative complications. There were 36 cases, including 13 cases (37.1%) of postoperative complications in the control group and 23 cases (28.1%) in the experimental group (28.1%). There was no significant difference in postoperative complications between the two groups. There was no significant difference between the groups of P0.05, TP1 and TP2. There was no significant difference between the two groups for infection, postoperative thrombosis and other cases. There were statistical differences in lymphatic cysts and urinary retention complications, P0.05. experimental group. In the experimental group, there was no statistical difference between the TP1 and TP2 groups in the experimental group. The difference in the positive rate of P0.05, lymph node metastasis and pulse tube infiltration was statistically different. The application of new adjuvant chemotherapy for the combination of force simple and oxaliplatin, and the combination of docetaxel and oxaliplatin in the P0.05. conclusion was feasible, and the curative effect was obvious; and in the follow-up. There were fewer bleeding and fewer complications after radical operation. It was worthy of clinical application. The combination of force simple and oxaliplatin combined with oxaliplatin combined with chemotherapy was close to the overall efficiency, but compared with the chemotherapy regimen of the combination of docetaxel and oxaliplatin, the toxic side of the combination chemotherapy of the combination of oxaliplatin and the combination of oxaliplatin and oxaliplatin Low use, better operation, lower incidence of postoperative lymph nodes and urinary retention complications, lower vaginal margin positive rate, lymph node metastasis, and positive rate of vascular infiltration, and so on.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.33

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