Matched-case comparison of neoadjuvant chemotherapy in patients with FIGO stage IB1-IIB cervical cancer to establish selection criteria
Matched-case comparison of neoadjuvant chemotherapy in patients with FIGO stage IB1-IIB cervical cancer to establish selection criteria
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DOI：
10.1016/j.ejca.2012.03.015
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发表时间：
2012-10-01
影响因子：
8.4
通讯作者：
Ma, Ding
中科院分区：
文献类型：
--
作者：
Hu, Ting;Li, Shuang;Ma, Ding
目的：宫颈癌新辅助化疗（NACT）仍存在争议。方法：对NACT组（n = 707）和初次手术治疗（PST; n = 707）组进行匹配病例比较，以调查短期反应和高/中风险因素（HRF/IRF）。5年无病生存率（DFS）和总生存率（OS）分别按NACT反应、HRF/IRF、国际妇产科联合会（FIGO）分期和肿瘤大小分层。与PST组相比，NACT组的IRF显著降低（P < 0.05），而HRF无显著降低（P> 0.05），5年DFS率显著提高（88.4% vs 83.1%，P = 0.021）。临床反应组5年无病生存率和总生存率明显高于PST组和临床无反应组（P < 0.05）。与临床无应答者相比，临床应答者的5年无病生存率（DFS）和总生存率（OS）也显著增加（P < 0.01）。在IB 2期，NACT组的5年DFS和OS率显著增加，而手术时间显著减少（P < 0.05）。结论：NACT是一种适合宫颈癌患者，尤其是NACT有效者和IB期患者的治疗方案，为年轻患者提供了一种新的生育保护理念。(C)2012爱思唯尔有限公司保留所有权利。
Objective: Neoadjuvant chemotherapy (NACT) for cervical cancer still remains controversial. NACT was evaluated to establish selection criteria.Methods: A matched-case comparison was designed for the NACT group (n = 707) and primary surgery treatment (PST; n = 707) group to investigate short-term responses and high/intermediate risk factors (HRFs/IRFs). The 5-year disease-free survival (DFS) and overall survival (OS) rates were stratified by NACT response, HRFs/IRFs, International Federation of Gynecology and Obstetrics (FIGO) stage and tumour size, respectively.Results: The clinical and pathological response rates were 79.3% and 14.9% in the NACT group. In comparison to the PST group, IRFs but not HRFs were significantly decreased (P < 0.05), and the 5-year DFS rate was significantly improved in the NACT group (88.4% versus 83.1%, P = 0.021). Moreover, the 5-year DFS and OS rates were favourably increased in the clinical responders in comparison to the PST group and the clinical non-responders (P < 0.05). Compared to those of clinical non-responders, the 5-year DFS and OS rates of clinical responders, with or without HRFs, were also significantly increased (P < 0.01). In stage IB2, the 5-year DFS and OS rates were significantly increased, whereas operation duration declined in the NACT group (P < 0.05). For patients with stage IB tumours of 2-5 cm, the 5-year DFS and OS rates of clinical responders were significantly improved (P < 0.05).Conclusions: NACT is a suitable option for patients with cervical cancer, especially for NACT responders and patients with stage IB, which provides a new concept of fertility preservation for young patients. (C) 2012 Elsevier Ltd. All rights reserved.