Prognosis of Cervical Cancer in the Era of Concurrent Chemoradiation from National Database in Korea: A Comparison between Squamous Cell Carcinoma and Adenocarcinoma.
Prognosis of Cervical Cancer in the Era of Concurrent Chemoradiation from National Database in Korea: A Comparison between Squamous Cell Carcinoma and Adenocarcinoma.
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DOI：
10.1371/journal.pone.0144887
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Won YJ
中科院分区：
文献类型：
--
作者：
Lee JY;Kim YT;Kim S;Lee B;Lim MC;Kim JW;Won YJ
1999年，美国国家癌症研究所发布了一份临床咨询报告，大力宣传顺铂为基础的放化疗（CCRT）对需要放射治疗的宫颈癌患者的优势。本研究旨在比较宫颈鳞癌和腺癌在CCRT出现前后的生存结局。数据来自1993年至2012年期间诊断为宫颈癌的韩国国家癌症发病率数据库。我们根据组织学亚型比较了在CCRT引入之前（1993-1997），期间（1998-2002）和之后（2003-2012）诊断的宫颈癌患者的生存率。共确定了80，766例患者，包括64，531例（79.9%）鳞状细胞癌和7，265例（9.0%）腺癌。随着CCRT的引入，两种组织学亚型的局部肿瘤患者的生存趋势逐渐增加。然而，无论治疗方式如何，鳞状细胞癌患者的生存率均显著高于腺癌患者（单纯手术，P < 0.001;手术后CCRT，P < 0.001;或原发性CCRT，P = 0.003）。多变量分析显示，腺癌是影响生存率的独立负性预后因素，与时间无关（CCRT前，风险比（HR）= 1.49; 95%置信区间（CI），1.37-1.62;引入CCRT后，HR = 1.40; 95% CI，1.30-1.50）。虽然腺癌的生存率在引入CCRT后有所改善，但在CCRT时代，腺癌的总生存率仍低于鳞状细胞癌。
In 1999, the National Cancer Institute issued a clinical advisory strongly touting the advantage of cisplatin-based chemoradiation (CCRT) for cervical cancer patients requiring radiation for their treatment. This study aimed to compare survival outcomes of cervical squamous cell carcinoma and adenocarcinoma before and after the advent of CCRT. Data were obtained from the Korea National Cancer Incidence Database for patients who were diagnosed with cervical cancers between 1993 and 2012. We compared survival according to histologic subtypes in cervical cancer patients diagnosed before (1993–1997), during (1998–2002), and after (2003–2012) the introduction of CCRT. A total of 80,766 patients were identified, including 64,531 (79.9%) women with squamous cell carcinomas and 7,265 (9.0%) with adenocarcinoma. With the introduction of CCRT, survival trends gradually increased in patients of both histologic subtypes with regional tumors. However, survival was significantly higher in squamous cell carcinoma than in adenocarcinoma patients regardless of treatment modalities (surgery alone, P < 0.001; surgery followed by CCRT, P < 0.001; or primary CCRT, P = 0.003). Multivariate analysis showed that adenocarcinoma was an independent negative prognostic factor for survival regardless of the time period (before CCRT, hazard ratio (HR) = 1.49; 95% confidence interval (CI), 1.37–1.62; after introduction of CCRT, HR = 1.40; 95% CI, 1.30–1.50). Although the survival of adenocarcinoma has improved after the introduction of CCRT, adenocarcinoma is still associated with worse overall survival compared to squamous cell carcinoma in the era of CCRT.