Randomized study of preoperative chemotherapy versus primary surgery for stage IB cervical cancer

医学 化疗 宫颈癌 阶段(地层学) 外科 子宫颈 病态的 内科学 新辅助治疗 癌症 乳腺癌 古生物学 生物
作者
Hongbing Cai,Hui‐Zhen Chen,Hou‐Han Yin
出处
期刊:Journal of Obstetrics and Gynaecology Research [Wiley]
卷期号:32 (3): 315-323 被引量:87
标识
DOI:10.1111/j.1447-0756.2006.00404.x
摘要

Abstract Aim: To determine the most effective treatment and long‐term outcome of patients with stage IB carcinoma of the cervix. Methods: From January 1999 to December 2001, 106 women with cervical cancer stage IB received neoadjuvant chemotherapy ( n = 52) or primary surgery ( n = 54). These were randomly assigned. Clinical effects and pathological changes were simultaneously recorded. Results: The overall clinical response rate was 84.6% and included a complete response (CR) in four patients (7.7%), partial response (PR) in 40 patients (76.9%), and stable disease (SD) in the remaining eight patients (15.4%). Surgery revealed positive nodes in 9.6% neoadjuvant chemotherapy group patients and in 29.6% primary surgery group patients ( P = 0.014). Similar results occurred with vascular space involvement: 27.8% in the primary surgery group compared to 9.6% in the neoadjuvant chemotherapy group ( P = 0.024). However, parametrial infiltration was found in 7.4% of the patients in the primary surgery group, while only 3.8% showed it in the neoadjuvant chemotherapy group ( P = 0.679). The overall 5‐year survival rate was significantly higher for all patients who received neoadjuvant chemotherapy (84.6%) than for the control group (75.9%) ( P = 0.0112). The median survival time in patients with complete response and partial response to chemotherapy (83.3 months) was significantly higher than that of patients with stable disease to chemotherapy (55.2 months) ( P = 0.0049). 27.3% of patients developed recurrent disease within 5 years of the primary treatment. The women with recurrence included partial response in six patients (60.0%), and stable disease in four patients (40.0%). For the other patients there was partial response and complete response in 38 patients (90.5%), and stable disease in the remaining four patients (9.5%) ( P = 0.035). Conclusion: Neoadjuvant chemotherapy can effectively eliminate the pathological risk factors and improve long‐term survival in patients with locally advanced cervical cancer.
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