Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors A 13-Year Experience
Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors A 13-Year Experience
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DOI：
10.1097/igc.0b013e31828703fd
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发表时间：
2013-03-01
影响因子：
4.8
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
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作者：
Okazawa, Mika;Mabuchi, Seiji;Kimura, Tadashi
目的：为了确定从术后辅助同步放化疗（CCRT）中获益的患者群体，我们回顾性研究了手术治疗的早期宫颈癌患者的生存结果。方法：回顾1996年1月至2009年12月间FIGO期IB1-IIB宫颈癌根治性子宫切除术后行辅助放疗（RT组124例）或辅助CCRT组192例（CCRT组192例）的病历。其中高危预后因素187例（高危组），中危预后因素129例（中危组）。60例未接受辅助治疗且伴有1项中危预后因素的患者作为对照（NFT组）。生存率采用Kaplan-Meier法计算，log-rank检验比较。结果：在高危组中，辅助CCRT在复发率、无进展生存期（PFS）和总生存期方面明显优于单纯RT。在中危组中，在有2个及以上危险因素的患者中，CCRT在复发率和PFS方面优于RT。在只有1个中危因素的患者中，虽然没有观察到CCRT相对于RT的生存获益，但在深部间质浸润患者中，与NFT组相比，添加辅助治疗可显著改善PFS （log-rank, P = 0.012）。结论：术后CCRT可改善FIGO分期IB1-IIB宫颈癌高危组及存在2个及以上中间危险因素患者的预后。单纯表现为深部间质浸润的患者也可从辅助治疗中获得临床获益。
Objectives: To identify groups of patients who derive clinical benefit from postoperative adjuvant concurrent chemoradiotherapy (CCRT), we retrospectively investigated the survival outcomes of surgically treated early-stage cervical cancer patients.Methods: We reviewed the medical records of 316 patients with FIGO stage IB1-IIB cervical cancer who had been treated with adjuvant radiotherapy (RT) (n = 124, RT group) or adjuvant CCRT (n = 192, CCRT group) after radical hysterectomy between January 1996 and December 2009. Of these, 187 patients displayed high-risk prognostic factors (high-risk group), and 129 displayed intermediate-risk prognostic factors (intermediate-risk group). Sixty patients with 1 intermediate-risk prognostic factor who received no adjuvant therapy were also identified and used as controls (NFT group). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test.Results: In the high-risk group, adjuvant CCRT was significantly superior to RT alone with regard to recurrence rate, progression-free survival (PFS), and overall survival. In the intermediate-risk group, CCRT was superior to RT with regard to recurrence rate and PFS in patents with 2 or more risk factors. Among the patients with only 1 intermediate-risk factor, although no survival benefit of CCRT over RT was observed, addition of adjuvant treatment resulted in significantly improved PFS compared with the NFT group in patients with deep stromal invasion (log-rank, P = 0.012).Conclusions: Postoperative CCRT improved the prognosis of FIGO stage IB1-IIB cervical cancer patients in the high-risk group and patients who displayed 2 or more intermediate-risk factors. Patients who displayed deep stromal invasion alone also derived clinical benefit from adjuvant treatment.