Adjuvant chemotherapy after surgery can improve clinical outcomes for patients with IB2-IIB cervical cancer with neoadjuvant chemotherapy followed by radical surgery.
Adjuvant chemotherapy after surgery can improve clinical outcomes for patients with IB2-IIB cervical cancer with neoadjuvant chemotherapy followed by radical surgery.
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术后辅助化疗可改善IB2-IIB宫颈癌新辅助化疗后根治性手术的临床结局
DOI：
10.1038/s41598-018-24413-z
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发表时间：
2018-04-24
影响因子：
4.6
通讯作者：
Ma D
中科院分区：
文献类型：
--
作者：
Sun H;Huang K;Tang F;Li X;Wang X;Long S;Zhou S;Suolangquzhen;Zhang J;Ning R;Li S;Wang S;Ma D
本研究的目的是评估宫颈癌患者接受新辅助化疗（NACT）后接受根治性手术的术后治疗的疗效。首先，本回顾性研究共纳入756例FIGO IB 2-IIB宫颈鳞状细胞癌（SCC）患者。然后采用393例患者的前瞻性队列数据进行进一步验证。评估总生存期（OS）和无病生存期（DFS）。在回顾性研究中，SCC患者根治性手术后接受辅助化疗的患者的OS相对优于未接受治疗的患者（P = 0.08，HR = 0.57）。在前瞻性队列研究中，结果更明显（P = 0.006，HR = 0.28）。在综合分析中，与未治疗相比，辅助化疗改善了临床结局（OS和DFS P = 0.002和0.04）。特别是对于宫颈外残留病变的患者，辅助化疗改善了OS（回顾性、前瞻性和联合研究中的对数秩P = 0.008、0.004和0.001）。最佳反应患者即使没有治疗也有良好的结局。我们的研究表明，辅助化疗可以改善SCC患者的临床结局，尤其是那些伴有宫颈外残留病变的患者。对于最佳缓解患者，可能不需要进一步治疗。这一发现需要在未来更多的研究中得到验证。
The aim of the study is to evaluate the efficacy of postoperative treatments based on pathological response for cervical cancer patients who received neoadjuvant chemotherapy (NACT) followed by radical surgery. Firstly, a total of 756 cervical squamous cell cancer (SCC) patients with FIGO IB2-IIB were included in this retrospective study. Then data from a prospective cohort of 393 patients was employed for further validation. Overall survival (OS) and disease-free survival (DFS) were assessed. In the retrospective study, SCC patients who accepted adjuvant chemotherapy after radical surgery had a relatively better OS than those who received no therapy (P = 0.08, HR = 0.57). The result was more noticeable in the prospective cohort study (P = 0.006, HR = 0.28). In the combined analysis, adjuvant chemotherapy improved clinical outcomes compared with no therapy (P = 0.002 and 0.04 for OS and DFS). Particularly for patients with extra-cervical residual disease, adjuvant chemotherapy improved OS (log-rank P = 0.008, 0.004 and 0.001 in the retrospective, prospective and combined studies). Optimal response patients had good outcomes even without therapy. Our study indicates that adjuvant chemotherapy can benefit clinical outcomes for SCC patients with NACT followed by radical surgery, especially those with extra-cervical residual disease. For optimal response patients, there may be no need for further treatment. This finding needs to be validated in more future studies.
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