第一临床医学院知识库

子宫颈癌是发病率仅次于乳腺癌的恶性肿瘤，严重影响女性健康。发展中国家由于卫生条件落后，不能有效的开展子宫颈癌筛查，大多数就诊的子宫颈癌患者诊断时已为晚期，预后较差。子宫颈癌的诊治策略为早期发现早期治疗。早期子宫颈癌的治疗最主要的方式是广泛性全子宫切除，而且早期子宫颈癌的预后较好。晚期子宫颈癌患者的诊疗是目前临床面临的难题，而根据最近国际妇产科联盟的年度报告，局部晚期子宫颈癌（locally advanced cervical cancer LACC, FIGO分期IB2-IIA期）相较早期子宫颈癌，更容易出现局部浸润和远处转移，预后较差。LACC严重威胁广大女性的健康及生命，成为妇科肿瘤学家必须要面对的一项挑战。为了探索能够改善LACC患者生存预后的治疗方法，已开展了化疗、放疗、手术治疗以及多种治疗方式结合的大量相关研究，以期寻找一种能够获得最好的临床治疗效果，最大限度地减少并发症的治疗方案。近年来，术前新辅助化疗（neoadjuvant chemotherapy，NACT）开始应用于LACC患者，既往研究发现术前NACT可以有效的局部控制肿瘤，缩小肿瘤从而降低手术难度并提供手术机会，降低远处转移的风险。NACT联合广泛性全子宫切除术治疗LACC的方案在经济落后的国家，尤其是放疗设备及专业人员缺乏的发展中国家更具有优势。

但是，NACT对LACC患者的治疗依然是充满争议。美国国家综合癌症网络(National Comprehensive Cancer Network, NCCN)子宫颈癌指南并不推荐对LACC患者使用NACT治疗方案。但是FIGO指南明确建议术前NACT是LACC患者可以选择的治疗方案。

因此，我们开展了一项有关LACC患者接受多种NACT方案的回顾性研究，探讨了NACT对LACC患者的临床疗效，以期今后更合理地选择病例、优化NACT方案，获得更好的NACT治疗效果，并探讨了为LACC的治疗方案提供新的理论基础。

The Incidence of cervical cancer is secondary only to breast cancer in the nationally wide，and is considered as one of the most common malignant tumor in women. For the limited sanitation condition and sources of the developing countries, it is unpractical to carry out cervical cancer screening effectively, and most of the patients with cervical cancer diagnosis have been at the late stages.

The extensive total hysterectomy is considered as the preliminary therapeutic strategy for early stage cervical cancer. The prognosis of the cervical cancer at early stages is satisfactory. According to a latest annual report from the international union of gynecology and obstetrics, the stage IB2 and type IIA cervical cancer (that is, locally advanced cervical cancer) are more prone to local invasion and distant metastasis with poorer prognosis compared with the cervical cancer at early stages. Therefore, the locally advanced cervical cancer acts as a serious threaten to the majority of women's health and life. It would be challenging for the gynecologic oncologists to explore treatments to improve the survival and prognosis of patients with locally advanced cervical cancer. Several therapeutics have been carried out including the chemotherapy, radiotherapy, surgery, and a variety of combined treatments with a large number of related research. In order to find an effective way to get the best clinical therapeutic effect, it would be crucial to retain function as far as possible and minimize the incidences of complications. Meanwhile, preoperative chemotherapy has been applied in patients with locally advanced cervical cancer. The preoperative adjuvant chemotherapy can be effective to control and shrink the tumor. This treatment could reduce the risks of operation, provide operation opportunity, and minimize the risk of distant metastases. This new locally advanced cervical cancer treatment is prevailing in these economically backward countries, especially the developing countries which are lack of radiation therapy equipment and professional staff. Preoperative chemotherapy could facilitate surgical treatment and solve the problem.

So far, the application of new adjuvant treatment is still controversial in these patients with locally advanced cervical cancer (FIGO staging IB2 - type IIA). The FIGO guidelines propose that the preoperative neoadjuvant chemotherapy should be considered as one of the treatment for these patients. However, the guidelines from National Comprehensive Cancer Network (National Comprehensive Cancer Network, NCCN) are different from the FIGO guidelines for patients with locally advanced cervical Cancer. They do not recommend the use of neoadjuvant chemotherapy for patients with locally advanced cervical cancer.

Several researches propose the use of neoadjuvant chemotherapy in patients with locally advanced cervical cancer. However, there is still no standard guidelines for which kind of neoadjuvant chemotherapy regimens is preferred.  Although most research suggest that the combined treatment should be based on the platinum. However, which kind of chemotherapy drugs, such as the vincristine, gemcitabine, paclitaxel, should be choose for neoadjuvant chemotherapy and attain the best clinical effect remain to be discussed. Therefore, we carried out a retrospective study based on locally advanced cervical cancer patients who received multiple neoadjuvant therapy. We explored new adjuvant chemotherapy for the treatment of patients with locally advanced cervical cancer, in order to optimize the treatment and offer therapeutic data for the future cases. Meanwhile, our results could provide theoretical basis to study the treatment for locally advanced cervical cancer.