Clinical Analysis Of 116 Cases Of Locally Advanced Cervical Cancer Treated With Different Treatment Methods

Objective To compare the clinical efficacy of different treatment regimens in patients with locally advanced cervical cancer and provide a theoretical basis for clinical treatment.Methods A total of 116 patients with stage IB2 and stage IIA2 cervical cancer who were admitted to the General Hospital of Ningxia Medical University from January 2011 to December 2015 were enrolled in this research.The clinical data were collected.According to different treatment groups: direct surgery group,preoperative neoadjuvant chemotherapy group(divided into preoperative arterial interventional chemotherapy group,preoperative intravenous chemotherapy group).Among the patients in the direct surgery group,after admission,perfect the preoperative examination,eliminate the surgical taboo,and then perform surgical treatment..Patients in the neoadjuvant chemotherapy group were given individualized chemotherapy for 1-2 cycles,and returned to hospital for surgery 21 days after the end of chemotherapy.Surgical methods were extensive hysterectomy + bilateral pelvic lymphadenectomy ± abdominal aortic lymph node sampling.The operation time,intraoperative blood loss,intraoperative and postoperative complications,average hospital stay,postoperative pathology,and 3-year cumulative PFS survival rate were compared between the three different treatment regimens.At the same time,the remission rate of clinical symptoms,the short-term effective rate and the incidence of adverse reactions were compared between the two groups of patients who received neoadjuvant chemotherapy before operation.Results(1)Analysis of operation time,intraoperative blood loss and clinical indexes:(1)The operation time of the direct operation group,preoperative arterial interventional chemotherapy group and preoperative intravenous chemotherapy group were3.04±0.53 h,2.70±0.49 h,2.75±0.58 h,respectively.The difference was statistically significant(p<0.01).There was a statistically significant difference between the direct surgery group and the other two groups(p<0.05),but there was no statistical difference between the other two chemotherapy groups.(p>0.05).(2)The intraoperative blood loss of the three groupswas438.14±236.35 ml,322.96±153.29 ml,and 345.33±169.70 ml,respectively.The difference was statistically significant(p<0.05).There was a statistically significant differencebetween the direct surgery group and the other two groups(p<0.05),but there was nostatistical difference between the other two chemotherapy groups.(p>0.05).(3)There wasno significant difference in intraoperative complications and infection among the three groups(p>0.05).(4)The difference in the three groups of hospitalization time was statistically significant(p<0.05).There was significant difference between the direct surgerygroup and the arterial interventional chemotherapy group(p<0.05),but there’s no diffeence between the direct surgery group and the intravenous chemotherapy group.Between the two chemotherapy groups,there was no statistical difference(p>0.05).(2)Postoperative pathological conditions:the incidence of lymphatic metastasis in the direct surgery group,the arterial interventional chemotherapy group,and the intravenous chemotherapy group was 62.71%,7.41%,and33.33%,respectively;the incidence of vascular involvement was 67.80%,11.11%,and40.00 % respectively;the incidence of deep infiltration of the cervix was 44.07%,14.81%,and 16.67%,respectively,and the differenceamong the three groups was statistically significant(p<0.05).Comparison of lymphatic metastasis,vascular infiltration,and deep interstitial infiltration of the cervix between the two groups.there were significant differences between the direct operation group and the chemotherapy group(p<0.05).There was a statistically significant difference in lymphatic metastasis and vascular invasion between the arterial interventional chemotherapy group and the intravenous chemotherapy group(p<0.05),but there was no significant difference in deep interstitial invasion of the cervix(p>0.05).(3)Clinical symptom relief rate: The effective response rate of clinical symptoms in the arterial interventional chemotherapy group was 62.96%,including 6 cases(22.22%)with complete symptom relief,5 cases(18.52%)with obvious remission,and 6 cases with moderateremission(22.22%);the effective response rate was 36.67% in the intravenous chemotherapy group,2 cases(6.67%)with complete symptom relief,4 cases(13.33%)with obvious remission,and 5 cases(16.67%)with moderate remission.The effective remission rate of the arterial interventional chemotherapy group was significantly better than that of the preoperative intravenous chemotherapy group.The difference between the two groups was statistically significant(p<0.05).(4)Short-term effective rate: The short-term effective rate of arterial interventional chemotherapy group was 74.07%,including 6 cases(22.22%)with complete remission and 14 cases(51.85%)with partial remission;the recent effective rate of intravenous chemotherapy group was 46.66%,including complete remission 4 in the case(13.33%),10 cases(33.33%)were partially relieved.The short-term efficacy of the arterial interventional chemotherapy group was better than that of the intravenous chemotherapy group,and the difference was statistically significant(p<0.05).(5)Incidence of chemotherapy adverse reactions:In the arterial interventional chemotherapy group,the incidence of hepatic and renal dysfunction,gastrointestinal reaction and I-III grade myelosuppression were 5 cases(18.52%),19 cases(70.37%)and 3 cases(11.11%),respectively.In the intravenous chemotherapy group,there were 6 cases(20.00%),22 cases(73.33%),and 2 cases(6.67%),respectively.The results of statistical analysis showed that the two groups were not statistically significant(p>0.05).(6)Survival analysis: The cumulative PFS survival rate of the three groups of patients was compared and analyzed for 3 years,and the difference was not statistically significant(p>0.05).Conclusion(1)Neoadjuvant chemotherapy can reduce the volume of tumor,reduce the amount of intraoperative bleeding,reduce the difficulty of operation,provide the possibility of complete resection of tumor during operation,and reduce the incidence of high risk pathological factors after operation.However,its effect on the long-term prognosis of patients is not clear.(2)Compared with intravenous systemic chemotherapy,arterial interventional embolization chemotherapy can better improve the clinical symptoms of patients,and improve the short-term effective rate,and the incidence of postoperative pathological lymph node metastasis and vascular invasion are significantly reduced,which is worthy of clinical promotion.