The Clinical Application And Evaluation Of Different Neoadjuvant Therapy In Local Ad-Vanced Cervical Cancer

Objective:1.To investigate the effect of different new adjuvant therapy in local advanced cervical cancer.2.To evaluate the clinical efficacy of different treatments for locally advanced cervical cancer by detecting the expression of MACC1 and Ki-67 in cervical cancer.Method : Retrospective analysis of 2010-2015 years for 260 cases of locally advancedcervical cancer admitted for surgical treatment of Maternal and Child Care Hospital of Gansu Province,divided into direct surgery(101 cases),neoadjuvant chemotherapy group(77 cases),neoadjuvant chemotherapy combined with brachytherapy group(82 cases),while the transfer of pathological paraffin blocks before operation after the colon cancer metastasis related gene 1(MACC1)and Ki-67 immunohistochemical detection,study of different treatment methods in reducing postoperative pathologic risk factors,local control rate,diseasefree survival(PFS)and overall survival(OS)whether there are differences and study the mechanism of action.Result : 1.NACT group compared with RH group can significantly reduce lympho vascular space invasion(19.48% vs.37.62%,P <0.05),but no significant to reduce positive margin,lymph node metastasis,parametrial extension,deep stromal invasion(P >0.05),NACT group in reducing postoperative adjuvant comparison of pelvic radiotherapy in RH group has no difference(66.23% vs.79.21%,P >0.05).2.In group NACT+BT,compared with group RH,the deep stromal invasion(42.68% vs.68.32%,P <0.05),parametrial extension(2.44% vs.12.87%,P <0.05)and lympho vascular space invasion(14.63% vs.37.62%,P <0.05)were significant decreased.The rate of postoperative adjuvant pelvic radiotherapy in the NACT+BT group was significantly less than the RH group(30.49% vs.79.21%,P <0.05).3.In group NACT+BT,compared with group NACT,the deep stromal invasion(42.68% vs.61.04%,P <0.05)significantly decreased,and the local tumor control rate(89.02% vs.76%,P <0.05)was significantly increased,and the rate of postoperative adjuvant pelvic radiotherapy was reduced(30.49% vs.66.23%,P <0.05).4.Five years PFS in NACT+BT group,NACT group and RH group were 77.22%,81.82% and 90.88% respectively(P <0.05),Five years OS were 91.13%,90.87% and 72.7% respectively(P = 0.2354).5.COX multivariate analysis showed that lymph node metastasis(HR=4.01,95%CI,1.51-10.69,P = 0.01)and positive margin(HR=3.01,95%CI,1.05-8.69,P = 0.04),will significantly reduce the PFS,parametrial extension will reduce the OS(HR= 10.17,95%CI 2.25-46.01,P <0.05).6.NACT+BT group and NACT group compared with RH group reduced the proliferation index of Ki-67(41.94±20.91 vs.30.97±19.99 vs.6.64±10.31,6.64±10.31,P < 0.05),enhanced the downregulating of MACC1(P <0.05);NACT+BT group compared with NACT group significantly decreased Ki-67 proliferation index(41.94±20.91 vs.30.97±19.99)and the expression of MACC1(47.06% vs.28.30%,P < 0.05).Conclusion:1.Neoadjuvant therapy can effectively reduce the volume of local tumor.2.Compared with the simple neoadjuvant chemotherapy and operation,the new adjuvant chemotherapy combined with brachytherapy can produce better local antitumor effect,which shows the increase of clinical remission rate and the reduction of local tumor volume.3.In reducing the depth of myometrium infiltration and the risk factors of recurrence of the vascular tumor thrombus,the new adjuvant chemotherapy combined with brachytherapy group is superior to the neoadjuvant chemotherapy plus the operation group and the direct operation group,thus reducing the rate of postoperative adjuvant radiotherapy.4.Neoadjuvant chemotherapy combined with brachytherapy can significantly reduce the expression of Ki-67 and MACC1,and reduce the risk of lymph node metastasis and deep myometrial invasion.5.The two new adjuvant therapies can significantly improve the tumor free survival of the patients with cervical cancer,and have shown a certain trend of improvement in the total life period,which is worth further study.