Tumor hypoxia has independent predictor impact only in patients with node-negative cervix cancer
Tumor hypoxia has independent predictor impact only in patients with node-negative cervix cancer
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DOI：
10.1200/jco.2002.20.3.680
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发表时间：
2002-02-01
影响因子：
45.3
通讯作者：
Hill, RP
中科院分区：
文献类型：
--
作者：
Fyles, A;Milosevic, M;Hill, RP
目的：这项前瞻性临床研究始于1994年，目的是验证肿瘤缺氧对宫颈癌晚期放疗患者预后的独立影响。患者和方法：1994年5月至1999年1月，106例符合条件的上皮性宫颈癌患者使用Eppendorf探针测量肿瘤氧压（PO2）。氧合数据以缺氧比例表示，定义为PO2读数小于5 mm/Hg的百分比（缩写为HP5）和中位PO2。结果：个体患者的中位HP为48%，中位PO2为HP5。缺氧肿瘤患者3年无进展生存率（PFS）为37%，而缺氧肿瘤患者3年无进展生存率为67% （P = 0.004）。在多因素分析中，只有肿瘤大小（风险比[RR]， 1.33; P =. 0003）和影像学检查盆腔淋巴结转移的证据（RR, 2.52; P =.0065）是PFS的预测指标。然而，观察到淋巴结状态与氧合之间的相互作用（P = 0.006），进一步分析表明，HP5是影像学阴性淋巴结患者预后的独立预测因子（P = 0.007）。缺氧组远处转移的3年累积发生率显著增加（HP患者41% vs 15%， < 50%; P = 0.0023），但盆腔复发无显著增加（37% vs 27%; P = 0.12）。结论：除肿瘤大小外，肿瘤缺氧仅是结阴性宫颈癌患者PFS差的独立预测因子。其影响似乎与远处转移的风险增加有关，而不是对骨盆控制的影响。(C) 2002年由美国临床肿瘤学会出版。
Purpose : This prospective clinical study was begun in 1994 to validate the independent prognostic impact of tumor hypoxia in patients with cervix cancer treated with definitive radiation therapy.Patients and Methods: Between May 1994 and January 1999, 106 eligible patients with epithelial cervix cancer had tumor oxygen pressure (PO2) measured using the Eppendorf probe. Oxygenation data are presented as the hypoxic proportion, defined as the percentage Of PO2 readings less than 5 mm/Hg (abbreviated as HP5) and the median PO2Results: The median HP, in individual patients was 48%, and the median PO2 was HP5. Progression-free survival (PFS) for patients with hypoxic tumors (HP.5 > 50%) was 37% at 3 years versus 67% in those patients with better oxygenated tumors (P = .004). In multivariate analysis, only tumor size (risk ratio [RR], 1.33; P = .0003) and evidence of pelvic nodal metastases on imaging studies (RR, 2.52; P =.0065) were predictive of PFS. However, an interaction between nodal status and oxygenation was observed (P = .006), and further analysis indicated that HP5 was an independent predictor of outcome in patients with negative nodes on imaging (P = .007). There was a significant increase in the 3-year cumulative incidence of distant metastases in the hypoxic group (41% v 15% in those with HP, < 50%; P = .0023), but not in pelvic relapse (37% v 27%; P = .12).Conclusion: Tumor hypoxia is an independent predictor of poor PFS only in patients with node-negative cervix cancer, in addition to tumor size. Its impact appears to be related to an increased risk of distant metastases rather than to an effect on pelvic control. (C) 2002 by American Society of Clinical Oncology.