Long-Term Outcomes of Cervical Cancer Patients Treated With Definitive Chemoradiation Following a Complete Metabolic Response.
Long-Term Outcomes of Cervical Cancer Patients Treated With Definitive Chemoradiation Following a Complete Metabolic Response.
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DOI：
10.1016/j.clon.2021.01.010
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Grigsby PW
中科院分区：
文献类型：
--
作者：
Lin AJ;Dehdashti F;Massad LS;Thaker PH;Powell MA;Mutch DG;Schwarz JK;Markovina S;Siegel BA;Grigsby PW
18f -氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）治疗后早期的完全代谢反应（CMR）是宫颈癌患者接受明确放化疗的积极预后因素，但该组患者的长期预后尚不清楚。确定失败模式和风险亚组。纳入了1998年至2018年接受国际妇产科联合会（FIGO） IB1-IVA期宫颈癌治疗意图放化疗并在治疗完成后5个月内进行FDG-PET CMR的患者。Cox比例风险模型确定了与局部、区域和远距离失效相关的因素。用Log-rank检验比较患者亚组无复发自由度（FFR）的Kaplan-Meier估计。有402例患者在FDG-PET放化疗后出现CMR。初始T分期为T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%)；初始FDG-avid淋巴结状态为无淋巴结(50%)/盆腔淋巴结(40%)/盆腔和主动脉旁淋巴结（10%）。中位随访6年后，109例（27%）复发。复发类型为局部（27%）、远处（61%）或两者兼而有之（12%）。没有因素与局部区域失败相关。在诊断时，T3-4病变（风险比= 2.4,95%可信区间为1.5-3.8）和盆腔（风险比= 1.6,95%可信区间为1.0-2.7）或主动脉旁淋巴结（风险比= 2.7,95%可信区间为1.4-5.0）的患者远处复发的可能性更大。T1-2患者诊断时无淋巴结、仅盆腔淋巴结或主动脉旁淋巴结的5年FFR分别为85,76和62% （P = 0.04，无与主动脉旁淋巴结相比）。T3-4患者诊断时无淋巴结、单独盆腔淋巴结或腹主动脉旁淋巴结的5年FFR分别为68%、56%和25% （P = 0.09，无与腹主动脉旁淋巴结相比）。T3-4肿瘤和主动脉旁淋巴结受累在诊断时是预后不良的因素，即使在放化疗后的CMR后也是如此。
A complete metabolic response (CMR) on early post-treatment 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a positive prognostic factor for cervical cancer patients treated with definitive chemoradiation, but long-term outcomes of this group of patients are unknown. Patterns of failure and risk subgroups are identified. Patients who received curative-intent chemoradiation from 1998 to 2018 for International Federation of Gynecology and Obstetrics (FIGO) stage IB1–IVA cervical cancer and had a CMR on post-treatment FDG-PET within 5 months of treatment completion were included. Cox proportional hazards models determined factors associated with locoregional and distant failure. Kaplan–Meier estimates of freedom from any recurrence (FFR) of patient subgroups were compared with Log-rank tests. There were 402 patients with a CMR after chemoradiation on FDG-PET. Initial T stage was T1 (38%)/T2 (40%)/T3 (20%)/T4 (2%); initial FDG-avid nodal status was no nodes (50%)/pelvic lymph nodes (40%)/pelvic and para-aortic lymph nodes (10%). After a median follow-up of 6 years, 109 (27%) recurred. The pattern of recurrence was locoregional (27%), distant (61%) or both (12%). No factors were associated with locoregional failure. Distant recurrence was more likely in patients with T3–4 lesions (hazard ratio = 2.4, 95% confidence interval 1.5–3.8) and involvement of pelvic (hazard ratio = 1.6, 95% confidence interval 1.0–2.7) or para-aortic lymph nodes (hazard ratio = 2.7, 95% confidence interval 1.4–5.0) at diagnosis. The 5-year FFR rates for T1–2 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 85, 76 and 62%, respectively (P = 0.04, none versus para-aortic nodes). The 5-year FFR for T3–4 patients with no nodes, pelvic nodes alone or para-aortic nodes at diagnosis were 68, 56 and 25%, respectively (P = 0.09, none versus para-aortic nodes). T3–4 tumours and para-aortic nodal involvement at diagnosis are poor prognostic factors, even after a CMR following chemoradiation.
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DOI：
10.1016/j.ijrobp.2018.11.012
发表时间：
2019-04-01
影响因子：
7
作者：
Lin, Alexander J.;Kidd, Elizabeth;Grigsby, Perry W.
通讯作者：
Grigsby, Perry W.
影响因子：
4.6
作者：
Han, Kathy;Leung, Eric;Bratman, Scott, V
通讯作者：
Bratman, Scott, V
影响因子：
28.4
作者：
Mayadev, Jyoti S.;Enserro, Danielle;Schilder, Russell J.
通讯作者：
Schilder, Russell J.
影响因子：
6.2
作者：
Srivastava, Amar J.;Contreras, Jessika A.;Grigsby, Perry W.
通讯作者：
Grigsby, Perry W.
影响因子：
3.9
作者：
Tangjitgamol, Siriwan;Tharavichitkul, Ekkasit;Lorvidhaya, Vichan
通讯作者：
Lorvidhaya, Vichan