Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer
Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patients with stage IB2/IIA2 cervical cancer
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DOI：
10.1016/j.ygyno.2012.11.006
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发表时间：
2013-03-01
影响因子：
4.7
通讯作者：
Linghu, Hua
中科院分区：
文献类型：
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作者：
Li, Rui;Lu, Shen-tao;Linghu, Hua
Objective.探讨术前新辅助化疗（NAC）对早期巨块型宫颈癌患者生存率的影响因素。对304例IB 2/IIA（2）期宫颈癌患者进行了回顾性分析。根据术前NAC与否分为两组：NAC组（n = 154）和初次手术组（PST，n = 150）。分析复发风险和生存率。总有效率为72.1%。对于NAC应答者，NAC降低了淋巴血管间隙浸润的比例（0 vs. 4.7%，p = 0.022; 0 vs. 3.3%，p = 0.052），深基质浸润（19.8% vs. 53.5%，p = 0.000; 19.8% vs. 29.3%，p = 0.08），淋巴结转移（8.1% vs. 25.6%，p = 0.004; 8.1% vs. 17.3%，p = 0.031），以及需要辅助放疗（5.5% vs. 30.2%，p = 0.000; 5.4% vs. 15.3%，p = 0.012），而5年PFS率提高（94% vs. 86%，p = 0.041; 94% vs. 80%，p = 0.089）和5年OS率（96% vs. 86%，p = 0.015; 96% vs. 82%，p = 0.05）。多因素分析提示NAC疗效是影响PFS的独立预后因素（HR 0.221，95% CI 0.048-1.022，p = 0.053）和OS（HR 0.126，95% CI 0.016-1.000，p = 0.05）;相比之下，HA期疾病对PFS有负面影响（HR 4.778，95%CI 1.490-15.317，p = 0.009）和OS（HR 4.142，95%CI 1.258-13.639，p = 0.019）。术前NAC治疗反应性可能是影响早期巨块型宫颈癌患者预后的独立因素。(C)2012 Elsevier Inc. All rights reserved.
Objective. To evaluate the factors that might affect the putative survival benefit from pre-operative neoadjuvant chemotherapy (NAC) in patients with early stage bulky cervical cancer.Methods. A retrospective review for 304 patients with stage IB2/IIA(2) cervical cancer was performed. Two groups were made according to pre-operative NAC or not: NAC group (n = 154) and primary surgery group (PST, n = 150). Recurrence risks and survival were analyzed.Results. The total response rate was 72.1%. For those NAC-responders, NAC decreased the ratio of lymphovascular space invasion (0 vs. 4.7%, p = 0.022; 0 vs. 3.3%, p = 0.052), deep stromal invasion (19.8% vs. 53.5%, p = 0.000; 19.8% vs. 29.3%, p = 0.08), lymph node metastasis (8.1% vs. 25.6%, p = 0.004; 8.1% vs. 17.3%, p = 0.031), and the need of adjuvant radiotherapy (5.5% vs. 30.2%, p = 0.000; 5.4% vs. 15.3%, p = 0.012), whereas improve 5-year PFS rate (94% vs. 86%, p = 0.041; 94% vs. 80%, p = 0.089) and 5-year OS rate (96% vs. 86%, p = 0.015; 96% vs. 82%, p = 0.05), as compared with non-responders and PST. Multivariate analysis suggested that the response to NAC is an independent prognostic factor of PFS (HR 0.221, 95% CI 0.048-1.022, p = 0.053) and OS (HR 0.126, 95% CI 0.016-1.000, p = 0.05); as compared, stage HA disease demonstrates negative impact upon PFS (HR 4.778, 95% CI 1.490-15.317, p = 0.009) and OS (HR 4.142, 95% CI 1.258-13.639, p = 0.019).Conclusion. Responsiveness of NAC before surgery might be an independent prognostic factor for the patients with early stage bulky cervical cancer. (C) 2012 Elsevier Inc. All rights reserved.