| Background and Objective Cervical cancer is the main cause of morbidity and mortality in women worldwide,and its morbidity and mortality are still increasing year by year.Locally Advanced Cervical Cancer(LACC)is refers to ?B2 and ?A2 stage patients whose tumor diameter are 4cm or more,and it was reported that the age of the patients was becoming more and more younger.The curative effect of radical hysterectomy is recognized effective in LACC.But the treatment of LACC have not reached in agreement because of its clinical features,for example its big cancer volume,the difficult of operation,easy to relapse and metastasis and poor of prognosis.To increase the prognosis of LACC,more and more scholars dedicate to the study of treatment method,and neoadjuvant chemotherapy(NACT)is becoming more and more widely used in clinical application,and large number of clinical studies have been operated and showed that the short-term effect of NACT is undoubted,but its impact on long-term prognosis of patients with cervical cancer is unclear.This research is aimed to analyse the clinical application value of neoadjuvant chemotherapy in locally advanced cervical cancer patients by the contrast analysis of patients with locally advanced cervical cancer.Materials and Methods 1.Materials Source: We Selected a total of 208 cases with stage of ?B2 and ?A2 patients with locally advanced cervical cancer who were treated in the first affiliated hospital of zhengzhou university during January 2012 to January 2014.We divided these patients into two groups,and analyzed those clinical data which were retrospectively.The two groups included preoperative chemotherapy group(NACT group)and no preoperative chemotherapy group(Directly operated group).The directly operated group had been given radical hysterectomy+pelvic lymph nodes,and it included 90 cases which contained 49 cases whose were in stage of ?B2 and 41 cases whose were in stage of ?A2.The NACT group had been given radical hysterectomy + pelvic lymph nodes after 1 or 2 cycles chemotherapy by arterial or intravenous,and it included 118 cases which contained 50 cases whose were in stage of ?B2 and 68 cases whose were in stage of ?A2.The young patients with cervical cancer of the two groups could reserve their ovary if their ovary is healthy,and the pathological types of them must be squamous cell carcinomas,and the ovary must be shifted in surgery.2.Observational index: The comparative analysis of two groups in intraoperative situation(intraoperative blood loss,operating time);The comparative analysis with postoperative complications situation of two groups;The comparative analysis with postoperative situation(the positive rate of cutting edge,the rate of lymph node metastasis,the rate of vascular positive,the rate of infiltration of the deep musculature,the rate of infiltration near the uterus,and whether to adjuvant therapy after operative);The survival situation analysis of two groups(disease-free survival and overall survival)the relapse situation analysis of two groups.3.Statistical methods: Spss17.0 statistical software was chosen for statistical analysis,The comparison of measuring data of two groups using t test,The comparison of classification data of two groups using chi-square test,using P = 0.05 as inspection level,and using P <0.05 as the difference is statistically significant?Results1.The comparison difference in general information between NACT group and Directly operated group on age,stage,pathological type,cancer size,histological classification was no statistically significant.2.The response of tumor to chemotherapy is favourable for most patients,and most of the size of tumor have different degrees of reduction: the total rate of effective was 81.36%,among them CR12.71%,PR68.64%,SD10.17%,there was no PD patient,based on the different period,pathological type and chemotherapy types,the analysis of comparison was no statistically significant difference in the rate of effective of chemotherapy(P>0.05).3.The comparison of intraoperative blood loss and operation time between NACT group and Directly operated group: the operation time of two groups were 191.65±40.30 min and 205.43±45.12 min,P>0.05,and there was no statistically significant difference;the Intraoperative blood loss of two groups respectively were 156±43.59 ml and 194±52.83 ml,P<0.05,the difference between them was statistically significant.4.The comparison of incidence of postoperative complications between NACT group and Directly operated group,such as urinary fistula(bladder or ureter injury),urinary retention,lymphatic retention cyst,lower extremity edema,stump poor healing,infection,etc.in NACT group,the complication rate was 36.41%(43/118),and 46.67%(42/90)in Directly operated group,P>0.05,and the difference between them was not statistically significant.5.The comparison about pathologic results and postoperative adjuvant therapy between NACT group and Directly operated group:the positive rate of cutting edge(4.24% and 11.11%),the rate of infiltration of the deep musculature(36.44% and 45.56%),the rate of infiltration near the uterus(5.93% and 6.67%),all P>0.05,the difference between them was not statistically significant.The rate of lymph node metastasis(21.19% and 37.78%),the rate of vascular positive(28.81% and 43.33%),and whether to adjuvant therapy after operative(92.37% and 98.89%),all P<0.05,the difference between them was statistically significant.6.The comparison of survival situation between NACT group and directly operated group: the death cases of two groups was 32,which 19 cases in NACTgroup and 13 cases in directly operated group.The 1 year DFS of two groups is respectively 98.20%,97.32%,1 year OS were 99.84% and 98.46% respectively,P>0.05,and the difference between them was not statistically significant.The 3-year DFS of two groups is respectively 74.31% and 69.85%,3 year OS were 79.83% and 75.72%,P>0.05,and the difference between them was not statistically significant.The 5 year DFS of two groups is 47.57% and 39.83% respectively,5 year OS were 58.40% and 50.53% respectively,P>0.05,and the difference between them was not statistically significant.7.The comparison of relapse between NACT group and directly operated group: there were 23 cases of recurrence,and the rate of recurrence was 19.49% in NACT group,there were 19 cases of recurrence,and the rate of recurrence was 21.11% in directly operated group,make a comparative analysis of two groups of the relapse,P>0.05,and the difference was not statistically significant.Conclusion1.Neoadjuvant chemotherapy could shrink the tumor volume obviously,increase the chance of operation,reduce the intraoperative bleeding lose.Because of these reasons,neoadjuvant chemotherapy is safe and effective in the near future curative effect.2.The neoadjuvant chemotherapy does not prolong the the disease-free survival and overall survival of patients with locally advanced cervical cancer,and it can not reduce the recurrence rate of patients with locally advanced cervical cancer.It may be related to the reason that neoadjuvant chemotherapy hides some high risk factors which affect the adjuvant therapy of postoperative. |
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