Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer.
Effectiveness of adjuvant systemic chemotherapy for intermediate-risk stage IB cervical cancer.
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DOI：
10.18632/oncotarget.22437
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发表时间：
2017-12-05
期刊：
影响因子：
--
通讯作者：
Sugiyama T
中科院分区：
文献类型：
--
作者：
Matsuo K;Shimada M;Yokota H;Satoh T;Katabuchi H;Kodama S;Sasaki H;Matsumura N;Mikami M;Sugiyama T
目的探讨中危IB期宫颈癌根治性子宫切除术后全身化疗的有效性。这是对之前组织的一项全国性队列研究的回顾分析，该研究调查了2004年至2008年间在日本接受根治性子宫切除术的6,003名IB-IIB期宫颈癌妇女。对555例中危组(深层间质侵犯50%、大肿瘤侵犯4 cm、淋巴血管侵犯[LVSI])的IB期宫颈癌患者的生存情况进行了分析：单纯化疗223例(40.2%)，同步放化疗172例(31.0%)，单纯放疗160例(28.8%)。最常见的中危类型是左心室梗死伴深间质侵犯(n=216，38.5%)。最常见的化疗选择是紫杉烷/铂(52.2%)。腺癌/腺鳞癌组织学类型的女性更有可能接受化疗(P=0.03)，而中危类型与化疗的使用无关(P=0.11)。多因素分析显示，接受全身化疗的患者的无瘤生存率(5年生存率，88.1%比90.2%，调整风险比(HR)0.98，95%可信区间(CI)0.52~1.83，P=0.94)和病因特异性生存率(95.4%比94.8%，调整后风险比0.85，95%可信区间0.34~2.07，P=0.71)与同期化疗组相似。在329名有多个中危因素的女性中也有类似的结果(化疗与同步放化疗的5年无病生存率分别为87.1%与90.2%，P=0.86；原因特定生存率94.6%与93.4%，P=0.82)。不同辅助治疗类型的累积局部复发(P=0.77)和远处复发(P=0.94)风险相似。我们的研究表明，全身化疗可能是中危IB期宫颈癌辅助治疗的替代治疗选择。
To examine the effectiveness of systemic chemotherapy following radical hysterectomy for women with intermediate-risk stage IB cervical cancer. This is a retrospective analysis of a previously organized nation-wide cohort study examining 6,003 women with stage IB-IIB cervical cancer who underwent radical hysterectomy between 2004 and 2008 in Japan. Survival of 555 women with stage IB cervical cancer in the intermediate-risk group (deep stromal invasion > 50%, large tumor size > 4 cm, and lympho-vascular space invasion [LVSI]) were examined based on adjuvant therapy patterns: chemotherapy alone (n = 223, 40.2%), concurrent chemo-radiotherapy (n = 172, 31.0%), and radiotherapy alone (n = 160, 28.8%). The most common intermediate-risk pattern was LVSI with deep stromal invasion (n = 216, 38.5%). The most common chemotherapeutic choice was taxane/platinum (52.2%). Women with adenocarcinoma/adenosquamous histology were more likely to receive chemotherapy (P = 0.03), and intermediate-risk pattern was not associated with chemotherapy use (P = 0.11). Women who received systemic chemotherapy had disease-free survival (5-year rate, 88.1% versus 90.2%, adjusted-hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.52–1.83, P = 0.94) and cause-specific survival (95.4% versus 94.8%, adjusted-HR 0.85, 95% CI 0.34–2.07, P = 0.71) similar to those who received concurrent chemo-radiotherapy on multivariable analysis. Similar results were seen among 329 women with multiple intermediate-risk factors (5-year rates for disease-free survival, chemotherapy versus concurrent chemo-radiotherapy, 87.1% versus 90.2%, P = 0.86; and cause-specific survival 94.6% versus 93.4%, P = 0.82). Cumulative local-recurrence (P = 0.77) and distant-recurrence (P = 0.94) risks were similar across the adjuvant therapy types. Our study suggests that systemic chemotherapy may be an alternative treatment choice for adjuvant therapy in intermediate-risk stage IB cervical cancer.
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