Pathologic complete remission after preoperative intracavitary radiotherapy of cervical cancer stage Ib and IIa is a strong prognostic factor for long-term survival:: analysis of the Radiumhemmet data 1989-1991
Pathologic complete remission after preoperative intracavitary radiotherapy of cervical cancer stage Ib and IIa is a strong prognostic factor for long-term survival:: analysis of the Radiumhemmet data 1989-1991
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DOI：
10.1046/j.1525-1438.2002.01089.x
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发表时间：
2002-03-01
影响因子：
4.8
通讯作者：
Lewensohn, R
中科院分区：
文献类型：
--
作者：
Beskow, C;Ågren-Cronqvist, AK;Lewensohn, R
本研究的目的是评估术前近距离放射治疗的治疗结果和术前腔内放疗后病理完全缓解对Ib和IIa期宫颈癌患者复发率和生存率的预后价值。本文回顾了1989年1月至1991年12月间收治的185例Ⅰ b期（129例）和Ⅱ a期（56例）宫颈癌的临床资料。中位随访时间为71个月。121例患者的治疗包括子宫阴道腔内照射，根据斯德哥尔摩技术，随后手术。术后病理学完全缓解（pCR）和病理学不完全缓解（non-pCR），对盆腔淋巴结转移或切缘残留肿瘤的患者术后加用外照射。对于术前腔内放疗和手术治疗的患者人群，Ib期和IIa期的疾病特异性5年生存率分别为87%和75%。腔内放疗后，79%的患者获得原发肿瘤的pCR。pCR患者的5年生存率为95%，而非pCR患者的5年生存率为46%（P < 0.0001）。pCR和无淋巴结转移患者的5年生存率为98%，而非pCR和淋巴结阴性患者的5年生存率为64%（P < 0.0001）。pCR患者的局部复发率为2%，而非pCR患者的局部复发率为54%（P < 0.0001）。多因素分析显示非pCR（RR = 6.42）和淋巴结阳性（RR = 4.59）是生存的不利因素，而肿瘤大小对生存没有独立意义。在淋巴结阴性患者中，腔内放疗后病理完全缓解是一个强有力的有利预后因素。术前腔内放疗和手术的结合导致高治愈率，并有助于识别可能接受辅助治疗的复发风险患者。
The purpose of this study was to evaluate the treatment results of preoperative brachytherapy and the prognostic value of pathologic complete remission after preoperative intracavitary irradiation in patients with stage Ib and IIa cervical carcinoma in relation to recurrence rate and survival. The clinical records of 185 patients with stage Ib (129 patients) and IIa (56 patients) cervical carcinoma, consecutively admitted to Radiumhemmet from January 1989 to December 1991 were reviewed. The median follow-up time was 71 months. In 121 patients the treatment consisted of uterovaginal intracavitary irradiation, according to the Stockholm technique, followed by surgery. Tumor remission assessed in the surgical specimen was classified as pathologic complete remission (pCR) if no microscopic tumor was found or incomplete pathologic remission (non-pCR) if microscopic residual tumor was found. Postoperative external beam radiation was added to cases with metastases in pelvic nodes or residual tumor in the resection margins. The disease-specific 5-year survival was 87% and 75% for stage Ib and IIa, respectively, for the patient population treated with preoperative intracavitary radiotherapy and surgery. After intracavitary radiation, 79% of the patients obtained pCR of the primary tumor. Five-year survival in those with pCR was 95%, compared with 46% in those with non-pCR (P < 0.0001). Patients with pCR and no lymph node metastases had a 98% 5-year survival as compared to a 5-year survival of 64% in patients with non-pCR and node negativity (P < 0.0001). Locoregional relapses were diagnosed in 2% of the patients with pCR compared to 54% in patients with non-pCR (P < 0.0001). Multivariate analysis revealed non-pCR (RR = 6.42) and node positivity (RR = 4.59) as nonfavorable factors for survival, while tumor size was not found to be of independent significance for survival. Pathologic complete remission after intracavitary irradiation is a strong favorable prognostic factor in node-negative patients. The combination of preoperative intracavitary radiotherapy and surgery results in a high cure rate and aids in identifying patients at risk for relapse who might be subject to adjuvant therapy.