Is Adjuvant Therapy Necessary for Patients with Intermediate-Risk Cervical Cancer after Open Radical Hysterectomy?
Is Adjuvant Therapy Necessary for Patients with Intermediate-Risk Cervical Cancer after Open Radical Hysterectomy?
复制标题
DOI：
10.1159/000508569
复制
发表时间：
2020-11-01
期刊：
影响因子：
3.5
通讯作者：
Kato, Kiyoko
中科院分区：
文献类型：
--
作者：
Yahata, Hideaki;Sonoda, Kenzo;Kato, Kiyoko
简介：对于中危宫颈癌患者（深部间质浸润[DSI]、淋巴管间隙浸润[LVSI]和巨大肿瘤），根治性子宫切除术后通常推荐辅助治疗。然而，我们先前报道DSI、LVSI和巨大鳞状细胞癌（SCC）在多变量分析中与预后无关;因此，我们使用的辅助治疗指征包括完全间质浸润，而不是DSI或LVSI或巨大SCC。本研究的目的是评估我们的治疗策略对宫颈癌根治性子宫切除术后的充分性。方法：我们在2001年至2013年期间对321例宫颈癌进行了III型开放性根治术。82名患有DSI、LVSI或巨大SCC的患者在知情同意的情况下在根治性子宫切除术后未接受辅助治疗。我们回顾性评估了这82例患者的预后。结果：DSI>2/3者42例，1/3-2/3者35例。5例患者仅发生LVSI。患者平均年龄为43岁（范围：27-72岁）。6例患者（7%）在中位随访期84个月（范围，1-206）期间复发。6例复发患者中有2例发生宫颈癌相关死亡，但其余4例在治疗后随访87-165个月仍存活，无疾病证据。5年无瘤生存率为92.6%，5年总生存率为96.3%。结论：开放式广泛子宫切除术后DSI、LVSI或巨大SCC的辅助治疗可能是不必要的。需要进一步收集数据，以确定中度风险宫颈癌患者的护理标准。
Introduction: Adjuvant therapy is usually recommended for patients with intermediate-risk cervical cancer (deep stromal invasion [DSI], lymphovascular space invasion [LVSI], and bulky tumor) after radical hysterectomy. However, we previously reported that DSI, LVSI, and bulky squamous cell carcinoma (SCC) were not correlated with prognosis in multivariate analysis; therefore, the indications we use for adjuvant therapy include complete stromal invasion, not DSI or LVSI or bulky SCC. The objective of this study was to evaluate the adequacy of our therapeutic strategy for cervical cancer after radical hysterectomy. Methods: We performed 321 type III open radical hysterectomies for cervical cancer between 2001 and 2013. Eighty-two patients with DSI, LVSI, or bulky SCC did not receive adjuvant therapy after radical hysterectomy under informed consent. We retrospectively evaluated the prognosis of these 82 patients. Results: Forty-two patients had >2/3 DSI and 35 patients had 1/3-2/3 DSI. Five patients had LVSI alone. The mean patient age was 43 years (range, 27-72). Six patients (7%) experienced recurrence during a median follow-up period of 84 months (range, 1-206). Two of the 6 patients with recurrence suffered cervical cancer-related deaths, but the remaining 4 cases are alive without evidence of disease after treatment during a follow-up period of 87-165 months. The 5-year disease-free survival rate was 92.6%, and the 5-year overall survival rate was 96.3%. Conclusions: Adjuvant therapy for DSI, LVSI, or bulky SCC after open radical hysterectomy might not be necessary. Further data collection is warranted to determine the standard of care for patients with intermediate-risk cervical -cancer.