临床ⅠB~ⅡB期宫颈癌直接手术和新辅助化疗后手术患者的手术-病理分期探讨

陈丹丹; 阳志军; 赵冰冰; 张洁清; 高琨; 王鹤; 李力

doi:10.3971/j.issn.1000-8578.2017.16.1440

临床ⅠB~ⅡB期宫颈癌直接手术和新辅助化疗后手术患者的手术-病理分期探讨

Surgery and Neoadjuvant Chemotherapy After Surgery on Surgical-pathologic Staging in Clinical ⅠB-ⅡB Period Cervical Cancer Patients

摘要

摘要:
目的探讨临床分期及手术-病理分期在临床ⅠB~ⅡB期宫颈癌诊治中的意义。
方法回顾性分析行手术治疗的388例ⅠB~ⅡB期宫颈癌患者的临床病理资料，分为直接手术（DS）和术前新辅助化疗（NACT）组，观察两组临床分期与手术-病理分期的差异。
结果临床分期与手术-病理分期符合率为：DS组21.1%，NACT组10%。临床检查对阴道及宫旁浸润判断的敏感度、特异性、准确度DS和NACT组分别为66.7%、20.0%，67.5%、70.9%，67.4%、69.7%和50.0%、85.7%，58.0%、46.0%，57.6%、47.6%。DS组不同分期的阴道、深肌层浸润差异有统计学意义（P < 0.05）。DS组以pTNM进行分期，癌栓是影响预后的因素（DFS: P=0.013, OS: P=0.004）；以FIGO分期，分期与预后密切相关（DFS: P=0.024, OS: P=0.050）。NACT组FIGO分期中的分期是影响复发的因素（P=0.023），而淋巴结转移与预后密切相关（DFS: P=0.004, OS: P=0.044）。
结论手术-病理分期与临床分期在ⅠB~ⅡB期宫颈癌中存在明显差异，其中ⅡB期的误差率最高，分期偏高导致本可手术的患者失去手术机会。

Abstract:
Objective To discuss the feasibility and importance of clinical staging and surgical-pathological staging in the treatment on stagesⅠB-ⅡB cervical cancer.
Methods We retrospectively analyzed the clinicopathological data of 388 patients with stagesⅠB-ⅡB cervical cancer who accepted surgical treatment. These patients were divided into preoperative neoadjuvant chemotherapy group (NACT group) and direct surgery group (DS group). The differences of the results were observed.
Results For surgical-pathological and clinical staging, the total coincidence rates were 21.1% in DS groups and 10% in NACT groups. For vaginal invasion, the sensitivity, specificity and accuracy were 66.7%, 67.5%, 67.4% in DS group and 50.0%, 58.0%, 57.6% and in NACT group; For parametrial invasion, the sensitivity, specificity and accuracy were 20.0%, 70.9%, 69.7% in DS group and 85.7%, 46.0%, 47.6% in NACT group respectively. The deep stromal invasion and vaginal invasion showed the distinct difference between each stage in DS group(P < 0.05). Tumor emboli could affect the prognosis in pTNM staging of DS group (DFS: P=0.013, OS: P=0.004); but in FIGO staging, staging was closely related to the prognosis (DFS: P=0.024, OS: P=0.050). In NACT group, the staging affected the recurrence(P=0.023), while lymph node metastasis was closely related to the prognosis (DFS: P=0.004, OS: P=0.044).
Conclusion With an obvious difference between surgical-pathological and clinical staging in stagesⅠB-ⅡB cervical cancer. There is a high percentage of discrepancy in clinical stage ⅡB. Due to the over-staging, many patients in clinical stage ⅡB lose the opportunities of surgery.

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