Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies
Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies
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DOI：
10.1016/j.ygyno.2015.04.035
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发表时间：
2015-07-01
影响因子：
4.7
通讯作者：
Ferrandina, G.
中科院分区：
文献类型：
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作者：
Legge, F.;Chiantera, V.;Ferrandina, G.
目标.疾病复发对宫颈癌患者来说是一个临床挑战，尤其是当所有可用的治疗方式都已在原发性环境中使用时。本研究的目的是分析局部晚期宫颈癌（LACC）患者的复发模式及其与临床结局的相关性接受初次放化疗（CTRT），然后进行根治性手术（RS）。方法。本研究对自1996年1月至2012年7月接受CTRT + RS治疗的364例LACC患者进行了研究。对于每次复发，检索关于临床/病理学复发日期和疾病表现模式的信息。复发后生存期（PRS）记录从复发之日至因疾病死亡或最后一次就诊之日。通过对数秩检验比较生存概率。采用逐步变量选择的考克斯回归模型对PRS的预后进行多因素分析。在中位随访42个月内，记录了75例复发（20.6%）和54例疾病相关死亡（14.8%）。复发部位以放射野外为主（43例，57.3%），内脏复发16例（21.3%）。在与PRS相关的复发参数中，包括复发模式、复发大小、复发时SCC-Ag血清水平和二次根治性手术，只有后者对降低死亡风险具有独立预测作用（p = 0.037）。二次根治性切除术的可行性对LACC患者接受多模式初次治疗的PRS有积极影响。(C)2015爱思唯尔公司All rights reserved.
Objectives. Recurrence of disease represents a clinical challenge in cervical cancer patients, especially when all available treatment modalities have been used in the primary setting.The aim of this study was to analyze the patterns of recurrence and their association with clinical outcome in locally advanced cervical cancer (LACC) patients submitted to primary chemoradiation (CTRT) followed by radical surgery (RS).Methods. This study was conducted on 364 LACC patients treated with CTRT plus RS since January 1996 to July 2012. For each relapse, information on date of clinical/pathological recurrence, and pattern of disease presentation were retrieved. Post-relapse survival (PRS) was recorded from the date of recurrence to the date of death for disease or last seen. Survival probabilities were compared by the log rank test. Cox's regression model with stepwise variable selection was used for multivariate prognostic analysis for PRS.Results. Within a median follow-up of 42 months, 75 recurrences (20.6%) and 54 disease-associated deaths (14.8%) were recorded. By analysing the pattern of relapse, most of the recurrences were outside the irradiated field (n = 43,57.3%) and the most frequently observed site was visceral (n = 16,213%). Among the parameters of the recurrence associated with PRS including the pattern of recurrence, the size of recurrence, SCC-Ag serum levels at recurrence, and secondary radical surgery, only the last one retained an independent predictive role in reducing the risk of death (p = 0.037).Conclusions. The feasibility of secondary radical resection positively impacts on PRS of LACC patients submitted to multimodality primary treatments. (C) 2015 Elsevier Inc. All rights reserved.