Analysis Of Treatment Models And Prognostic Factors In Patients With Locally Advanced Cervical Cancer(ⅠB2 Stage)

Objective:Cervical cancer is the highest incidence of malignant tumors in women except breast cancer,and the incidence has increased in recent years.There are approximately 500,000 new cases of cervical cancer worldwide each year,most of them in developing countries.In China,there are about 135,000 new cases of cervical cancer every year,and a considerable proportion of patients have reached the late stage of treatment,becoming one of the important causes of cancer death for women.The efficacy of cervical cancer radical surgery for early cervical cancer is certain,but there is still great controversy for the treatment of locally advanced cervical cancer(IB2-IIA2).The operation of locally advanced cervical cancer(IB2-IIA2)is difficult,and it is easy to relapse and metastasis after operation.The 5-year survival rate is low.It is reported in the literature that the 5-year survival rate is only about 50%.In the past 10 years,with the research of domestic and foreign scholars,various treatment models have been developed for locally advanced cervical cancer(IB2-IIA2),such as neoadjuvant chemotherapy,direct surgery,postoperative adjuvant chemotherapy,concurrent chemoradiotherapy,and others.A certain therapeutic effect.However,for the prognosis of patients with stage IB2 in locally advanced cervical cancer and the best treatment model,its prognosis,related factors affecting prognosis,and the best treatment model need to be further studied.Neoadjuvant chemotherapy refers to the chemotherapy given before local treatment of malignant tumors(surgery or radiotherapy).Its advantages can reduce the tumor volume and facilitate the next treatment;it can increase the sensitivity of radiotherapy;it can eliminate micrometastases and reduce recurrence.There is positive significance for the treatment of locally advanced cervical cancer(IB2-IIA2),but there is still great controversy.In this study,patients with stage IB2 cervical cancer were treated with neoadjuvant chemotherapy + surgery and surgery alone,and the information of the two groups was recorded.It was analyzed whether the application of neoadjuvant chemotherapy in patients could improve the quality of life of patients.Provide ideas for clinical treatment.Method:1.Source: 80 cases of patients with stage IB2 cervical cancer admitted to the Fourth Hospital of Hebei Medical University from February 2008 to February 2011 were selected.Through retrospective analysis of clinical case data,the treatment modes of selected patients were divided into neoadjuvant chemotherapy + surgery,direct surgery,postoperative adjuvant radiotherapy or chemotherapy and other comprehensive treatment modes.The neoadjuvant chemotherapy group consisted of 40 patients in the NACT group and 40 in the direct surgery group.In the neoadjuvant chemotherapy group,after excluding chemotherapy contraindications,the patient was given 1-2 cycles of paclitaxel carboplatin chemotherapy,followed by extensive abdominal hysterectomy + pelvic lymph node dissection 2 weeks after the end of chemotherapy.In the direct surgery group,after the exclusion of surgical contraindications,abdominal general hysterectomy + pelvic lymph node dissection was performed directly.If there were young patients in both groups and the ovary had no lesions,they were reserved and shifted.Patients in each group performed routine support symptomatic treatment on the basis of treatment.Through reviewing medical records,follow-up(including telephone follow-up,out-patient follow-up,letters)and other methods,the related factors that affect patient’s 3-year,5-year survival rate,quality of life and other factors were reviewed.Analysis 1 The incidence of postoperative recurrence risk factors in the two groups of patients had no difference,including: deep muscular layer infiltration,parametrial infiltration,lymph node metastasis,vascular cancer e m b o l i s m,v a g i n a l s t u m p w i t h o r w i t h o u t r e s i d u a l l e s i o n s;survival rate of the two groups of patients。There was no difference in tumorfree survival,including three-year,5-year survival,and tumor-free survival,differences in survival and disease-free survival between patients receiving adjuvant radiotherapy or chemotherapy in both groups.Analysis of single factor effects on prognosis: including tumor grade,pathological type,age,lymph node metastasis,vascular tumor embolus,deep muscular layer infiltration,parametrial metastasis,vaginal stump with or without residual tumor and postoperative adjuvant therapy;6 quality of life analysis2.Statistical analysis: Data were analyzed by SPSS 19.0 software.The quantitative data of the two groups were expressed as mean±standard deviation(X±s).The age,operation time,intraoperative blood loss,and number of lymph node dissection were measured by t test.Analysis;Qualitative data in the two groups were expressed as rates and analyzed using chi-square test;survival curves were plotted using Kaplan-Meier method;logrank test was used for group differences,single factor analysis,and multivariate analysis was performed using a COX proportional hazards regression model.The test level was a=0.05,P<0.05 was considered statistically significant.Result:1.The overall effective rate of preoperative neoadjuvant chemotherapy was 75%,of which 10%(4/40)were complete remission,65%(26/40)partial remission,and 25%(10/40)stable.Progressive patients.The effective rates of different tissue types were compared.The effective rates of squamous cell carcinoma and non-squamous cell carcinoma were 74% and 73%,respectively(P=0.492>0.05).The difference was not statistically significant.2.Intraoperative comparison between neoadjuvant chemotherapy group and direct surgery group: The operation time of neoadjuvant chemotherapy group and direct surgery group were: 225.75±41.89 min,238.75±54.79min(P=0.279>0.05).The intraoperative blood loss was 366.09±179.94 ml and 434.20±167.91 ml,respectively(P=0.024<0.05).The blood loss was statistically different between the two groups.The number of lymphatic resections was 25.08±6.89 and 24.62±7.45(P=0.821>0.05),which were not statistically different.Tumor volume shrinks.3.Comparison of risk factors for recurrence after neoadjuvant chemotherapy and direct surgery: The incidence of deep myometrial invasion,parametrial infiltration,lymph node metastasis,vascular embolism and residual vaginal residual lesions in the neoadjuvant chemotherapy group was 15%(6/40),18%(7/40),15%(6/40),12%(5/40),and 10%(4/40);deep muscle infiltrates,parametrial infiltration,lymph nodes in the direct surgical group The incidence of metastases,vascular embolism,and residual vaginal lesions were: 17%(7/40),20%(8/40),25%(10/40),15%(6/40),and 18 %(7/40).There was no statistical difference between deep muscle invasion(P=0.136>0.05)and vascular embolism(P=0.421>0.05)in the incidence of high risk factors in both groups.The incidence of parametrial infiltration(P=0.023),lymph node metastasis(P=0.012),and residual vaginal lesions(P=0.043)was statistically significant(P<0.05).4.Comparison of 3y-PFS,3y-OS,5y-PFS,and 5y-OS between neoadjuvant chemotherapy and direct surgery: 3y-PFS and 3y-OS survival analysis.There were 7 deaths in both groups,and neoadjuvant chemotherapy 3 Cases,direct surgery group 4 cases.The 3y-PFS neoadjuvant chemotherapy group and the direct surgery group were 91.56% and 78.45%,respectively.Log-rank test was used to test,P= 0.025 <0.05,the difference between the two groups was statistically significant.3y-OS was 92.50% and 90.00%,respectively,and was tested by log-rank test,P=0.868>0.05.There was no significant difference between the two groups;5y-PFS and 5y-OS survival analysis of the total number of deaths in both groups In 19 patients,neoadjuvant chemotherapy was performed in 8 patients and direct surgery in 11 patients.In the 5y-PFS neoadjuvant chemotherapy group and direct surgery group,they were 81.80% and 71.58%,respectively,log-rank test was used to test,P=0.032<0.05,and the difference between the two groups was statistically significant.5y-OS was 82.00% and 72.5%,,and was tested by logrank test,P=0.033<0.05.5.Univariate analysis of prognosis of cervical cancer: Univariate analysis: Lymph node metastasis,vascular embolization,deep muscle infiltration,residual tumor in the vaginal stump,and neoadjuvant chemotherapy are factors influencing the disease-free survival of patients with cervical cancer(P<0.05).Pathological types,lymph node metastasis,vascular embolism,cervical deep muscle infiltration,residual lesions in the vaginal stump,and adjuvant chemotherapy were factors that affected overall survival(P<0.05).6.Multivariate analysis of prognosis of cervical cancer: Lymphatic metastasis,vascular embolism and residual tumor of vaginal end are independent risk factors for PFS(P<0.05);pathological types,lymphatic metastasis,vascular embolism,and vaginal rupture Tumor foci were an independent risk factor for OS(P<0.05);preoperative adjuvant chemotherapy was a protective factor(OR,0.315;95% CI,0.081 to 0.948,P=0.042).The OR of the pathological type,lymph node metastasis,vascular embolism,and residual vaginal tumor lesions were: 3.091,2.013,2.120,1.231,and 1.081.Conclusion:1.The overall effective rate of NACT group was 75%.There was no difference in different tissue types,and the amount of blood in NACT patients was less;2.The incidence of parametrial infiltration,lymph node metastasis and residual vaginal lesions in NACT patients was low;3.The 3y-PFS and 5y-PFS of NACT patients were longer,with significant difference;4.Lymphatic metastasis,vascular embolism and residual tumors in vaginal amputation are independent risk factors for PFS;pathological type,lymphatic metastasis,vascular embolism and the presence of tumors at vaginal ends are independent risk factors for OS.Preoperative adjuvant chemotherapy is a protective factor;5.For patients with locally advanced cervical cancer(IB2),NACT can improve the quality of life after surgery.