| Cervical cancer is the first gynecological malignant tumor.The incidence of Western developed countries is slowly decreasing worldwide,but the incidence of cervical cancer is increasing in most developing countries.Mainly,the middle and late treatment is mainly based on radiotherapy,supplemented by chemotherapy.In recent years,the treatment of cervical cancer has been constantly regulated and improved,but the survival rate has been difficult to achieve substantial improvement.In China,there are about 140,000 new cases of cervical cancer and about 37,000 deaths.In recent years,the incidence of locally advanced cervical cancer in FIGO stage ?B2 and ?A2 has increased significantly,and the age of onset has become younger.Since 1982,Feri has defined Neoadjuvant Chemotherapy(NACT)for the first time.Neoadjuvant chemotherapy for cervical cancer has received increasing attention from scholars at home and abroad.It has been reported in the literature that neoadjuvant chemotherapy(NACT)is in the era of radiotherapy and chemotherapy.There is an uncertain effect,and most patients have local advanced disease at the time of presentation.In countries where Radiation Therapy(RT)is limited,NACT can help patients achieve effective treatments.Neoadjuvant chemotherapy for cervical cancer is highly regarded in China.However,in recent years some studies have shown that the effects of neoadjuvant chemotherapy need to be further verified.A prospective randomized controlled trial published in 2018 compared the effects of neoadjuvant chemotherapy and direct concurrent chemoradiotherapy for locally advanced cervical cancer.It was found that neoadjuvant chemotherapy plus surgery had a 5-year disease-free survival rate worse than concurrent chemoradiotherapy.The earlier GOG 141 study compared the effects of preoperative plus no chemotherapy in stage IB cervical cancer and found that chemotherapy was not beneficial.To date,NCCN guidelines still do not recommend neoadjuvant chemotherapy for locally advanced cervical cancer.This article summarizes the cases of neoadjuvant chemotherapy+surgical treatment in patients with locally advanced cervical cancer of ?B2 and ?A2,and the effect of neoadjuvant chemotherapy on surgery and prognosis in the separate surgery group.OBJECTIVE:To compare the effects of neoadjuvant chemotherapy on the feasibility and pathological prognostic factors and survival rate of ?B2 and ?A2 cervical cancer after extensive hysterectomy.METHODS:A total of 66 patients with ?B2 and IIA stage2 locally advanced cervical cancer who were treated in Obstetrics and Gynecology Hospital of Dalian from January2009 to April2013 were retrospectively studied.All cases were complete.Clinical and pathological data.A total of 37 patients in the neoadjuvant chemotherapy plus surgery group were enrolled in the study group,and 29 patients in the control group were treated with no chemotherapy contraindications.All patients underwent extensive hysterectomy and pelvic cavity after neoadjuvant chemotherapy.Lymph node dissection,partial abdominal aortic lymph node sampling,29 patients in the control group underwent extensive hysterectomy and pelvic lymphadenectomy,and some abdominal aortic lymph nodes were sampled.Observed pelvic lymph node metastasis,depth of cervical myometrial invasion,vascular tumor thrombus,parametrial infiltration and vaginal invasive tumor infiltration,and compared the surgical quality-related factors with the surgery group,and discussed the overall survival of the two groups and none.Disease survival period.RESULTS:A total of 66 patients underwent a retrospective study.Of the 37 patients in the neoadjuvant+surgical group,29 underwent surgery directly.The follow-up period was 12-108 months.The rate of loss of follow-up was 19.6%.The median age of the patients was new.The assistant group(47.2±8.40 years old)vs the operation group(43.9±8.92 years old),the FIGO staging neoadjuvant group,25 cases of ?B2 stage,12 cases of stage ?A2,24 cases of ?B2 stage,5 cases of stage ?A2,most of the pathological types were There were57 cases(86%)of squamous cell carcinoma,4 cases of adenocarcinoma,3 cases of adenosquamous carcinoma andl case of small cell carcinoma.There were no significant differences in pelvic lymph node metastasis,depth of cervical myometrial invasion,vascular tumor thrombus,parametrial infiltration and vaginal invasive tumor infiltration in both groups(P>0.05).There was no significant difference in operation time between the two groups.(190(175,202.5))VS surgery group(195(155.220))(P>0.05),but in terms of bleeding volume,the neoadjuvant group was significantly higher than the direct surgery group,the neoadjuvant group(700(425,900))VS surgery group VS(500(325.600))(P[0.05).The average overall survival of the neoadjuvant group was74.65(25-108)months,60.67(12-103)months in the surgery group,71.57(12-108)months in the neoadjuvant group,and57.23 in the surgery group.There was no significant difference(P]0.05)between 6 and 107 months.Conclusion:For patients with locally advanced cervical cancer of ?B2 and ?A2,neoadjuvant chemotherapy plus surgery can not reduce pathological prognostic factors compared with direct surgery,and there is no significant improvement in overall survival and progression-free survival.The amount of bleeding,neoadjuvant chemotherapy is not recommended for the treatment of such patients,the patient should be carefully and individually evaluated to determine the best treatment. |
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