The trend and outcome of postsurgical therapy for high-risk early-stage cervical cancer with lymph node metastasis in Japan: a report from the Japan Society of Gynecologic Oncology (JSGO) guidelines evaluation committee.
The trend and outcome of postsurgical therapy for high-risk early-stage cervical cancer with lymph node metastasis in Japan: a report from the Japan Society of Gynecologic Oncology (JSGO) guidelines evaluation committee.
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DOI：
10.3802/jgo.2021.32.e44
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发表时间：
2021-05
影响因子：
3.9
通讯作者：
Mikami M
中科院分区：
文献类型：
--
作者：
Ikeda M;Shida M;Shigeta S;Nagase S;Takahashi F;Yamagami W;Katabuchi H;Yaegashi N;Aoki D;Mikami M
日本妇科肿瘤学会于2007年发布了首份宫颈癌治疗指南。本研究的目的是评估首个指南的引入对早期宫颈癌手术患者的临床趋势和预后的影响。该分析包括9,756例基于病理肿瘤-淋巴结转移（pTNM）分类（即pT1b1， pT1b2， pT2b和pN0， pN1, pNX）诊断并在2004年至2009年期间接受手术作为主要治疗的患者。回顾性回顾这些患者的资料，并评估临床病理趋势。采用竞争风险模型确定指南的引入对生存的影响。对于手术病例，竞争风险模型对年龄、注册年份、pT分类、pN分类、组织学类型和治疗方法调整后的指南影响的估计亚分布风险比（HR）为1.024 （p=0.864）。自2007年第一个指南出台以来，对于淋巴结转移患者，化疗（CT）作为术后治疗的使用增加，而同步放化疗(CCRT)/放疗（RT）的使用减少（p<0.010）。对于pN1病例，竞争风险模型对指南影响的估计亚分布HR为1.094 （p=0.634）。CT与CCRT/RT在术后治疗方面比较，差异无统计学意义（p=0.078）。指南的引入并没有提高手术病例的生存率。对于高危早期宫颈癌，有必要考虑更有效的术后治疗。
The Japan Society of Gynecologic Oncology published the first guidelines for the treatment of cervical cancer in 2007. The aim of this research was to evaluate the influence of the introduction of the first guideline on clinical trends and outcomes of patients with early-stage cervical cancer who underwent surgery. This analysis included 9,756 patients who were diagnosed based on the pathological Tumor-Node-Metastasis (pTNM) classification (i.e., pT1b1, pT1b2, pT2b and pN0, pN1, pNX) and received surgery as a primary treatment between 2004 and 2009. Data of these patients were retrospectively reviewed, and clinicopathological trends were assessed. The influence of the introduction of the guideline on survival was determined by using a competing risk model. For surgery cases, the estimated subdistribution hazard ratio (HR) by the competing risk model for the influence of the guideline adjusted for age, year of registration, pT classification, pN classification, histological type, and treatment methods was 1.024 (p=0.864). Following the introduction of the first guideline in 2007, for patients with lymph node metastasis, the use of chemotherapy (CT) as a postsurgical therapy increased, whereas that of concurrent chemoradiotherapy (CCRT)/radiotherapy (RT) decreased (p<0.010). For pN1 cases, the estimated subdistribution HR by the competing risk model for the influence of the guideline was 1.094 (p=0.634). There was no significance in the postsurgical therapy between CT and CCRT/RT (p=0.078). Survival of surgical cases was not improved by the introduction of the guidelines. It is necessary to consider more effective postsurgical therapy for high-risk early-stage cervical cancer.