Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery.
Young Cervical Cancer Patients May Be More Responsive than Older Patients to Neoadjuvant Chemotherapy Followed by Radical Surgery.
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年轻宫颈癌患者可能比老年患者对新辅助化疗后根治性手术的反应更好
DOI：
10.1371/journal.pone.0149534
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Li S
中科院分区：
文献类型：
--
作者：
Zhou J;Li X;Huang K;Jia Y;Tang F;Sun H;Zhang Y;Zhang Q;Ma D;Li S
目的探讨年龄对宫颈癌根治术后新辅助化疗（NACT）疗效的影响。方法回顾性分析1014例晚期宫颈癌行NACT手术后根治性手术的患者。患者分为青壮年组（年龄≤35岁，n = 177）和老年组（年龄≤35岁，n = 837）。我们比较了两组之间的短期反应和存活率。5年无病生存率（DFS）和总生存率（OS）按年龄、NACT反应和FIGO分期分层。结果青年组总有效率为86.8%，老年组总有效率为80.9%。年轻患者FIGO分期较早（P<0.001），腺癌发生率较高（P = 0.022），淋巴结转移率较高（P = 0.033）。组织学类型为腺癌（P = 0.024）和淋巴结转移阳性（P<0.001）被确定为生存的独立危险因素。当按年龄和临床反应分层时，与其他亚组相比，对NACT无反应的年轻患者的临床病理状况更差。与无应答者相比，NACT应答者在年轻患者中具有更高的5年DFS率（80.1%比71.8%,P = 0.019）和OS率（82.6%比71.8%,P = 0.003），而在老年患者中则没有。结论35岁以下对NACT有反应者从NACT中获益最多，而年轻无反应者获益最少。当对宫颈癌患者实施NACT时，年龄可能是一个需要考虑的重要因素。
Objective To evaluate the effects of age and the clinical response to neoadjuvant chemotherapy (NACT) in patients with cervical cancer who received neoadjuvant chemotherapy followed by radical surgery. Methods A total of 1,014 patients with advanced cervical cancer who received NACT followed by radical surgery were retrospectively selected. Patients were divided into young (aged ≤35 years, n = 177) and older (aged >35 years, n = 837) groups. We compared the short-term responses and survival rates between the groups. The five-year disease-free survival (DFS) and overall survival (OS) rates were stratified by age, NACT response, and FIGO stage. Results The overall response rate was 86.8% in the young group and 80.9% in the older group. The young patients had an earlier FIGO stage (P<0.001), a higher rate of adenocarcinoma (P = 0.022), and more lymph node metastasis (P = 0.033) than the older patients. The presence of adenocarcinoma as the histological type (P = 0.024) and positive lymph node metastasis (P<0.001) were identified as independent risk factors for survival. When stratified by age and clinical response, young patients with no response to NACT had a worse clinicopathological condition compared with the other subgroups. Compared with non-responders, responders to NACT had a higher five-year DFS rate (80.1% versus 71.8%; P = 0.019) and OS rate (82.6% versus 71.8%; P = 0.003) among the young patients but not among the older patients. Conclusions Responders to NACT aged 35 years or younger benefitted the most from NACT, while the young non-responders benefitted the least. Age might represent an important factor to consider when performing NACT in patients with cervical cancer.