Comparison of adjuvant therapy for node-positive clinical stage IB-IIB cervical cancer: Systemic chemotherapy versus pelvic irradiation.
Comparison of adjuvant therapy for node-positive clinical stage IB-IIB cervical cancer: Systemic chemotherapy versus pelvic irradiation.
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DOI：
10.1002/ijc.30793
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发表时间：
2017-09-01
影响因子：
6.4
通讯作者：
Sugiyama T
中科院分区：
文献类型：
--
作者：
Matsuo K;Shimada M;Aoki Y;Sakamoto M;Takeshima N;Fujiwara H;Matsumoto T;Mikami M;Sugiyama T
这是一项在日本进行的全国范围的回顾性研究，研究对象为2004年至2008年因临床分期IB-IIB宫颈癌伴盆腔和/或主动脉旁淋巴结转移而接受根治性子宫切除术的女性。根据辅助治疗模式比较复发或死亡时间和疾病复发模式：全盆腔放疗（n = 253），同步放化疗（CCRT，n = 502）和化疗（n = 319）。单独接受化疗的女性复发率相似（5年发生率，36.6% vs. 34.1%，调整风险比[HR] 0.95，95%置信区间[CI] 0.70-1.28，P = 0.72）和宫颈癌死亡率（24.7% vs. 21.8%，调整后HR 0.96，95% CI 0.67-1.38，P = 0.83）多变量分析显示，与接受CCRT的患者相比，然而，当对复发模式进行分层时，化疗治疗与远处复发风险降低独立相关（5年累积率，19.2% vs. 24.6%，调整后HR 0.47，95% CI 0.31-0.71，P < 0.001），但局部复发风险增加（23.9% vs. 14.3%，调整后HR 2.03，95% CI 1.34-3.08，P = 0.001）。非鳞状细胞癌、宫旁组织受累和高淋巴结比率是局部复发的独立预测因素，化疗组中存在多个危险因素与5年累积局部复发率高相关：无危险因素3.9%，单一危险因素14.2- 22.1%，多个危险因素27.8-71.9%（P < 0.001）。总之，虽然表现出不同的复发模式，全身化疗可能是有效的术后治疗为基础的放射治疗淋巴结阳性的高危期IB-IIB宫颈癌。当肿瘤表现出某些危险因素时，单纯化疗可能不足以局部控制，在该亚组中建议在全身化疗的基础上增加盆腔放疗。
This was a nation-wide retrospective study in Japan examining women who underwent radical hysterectomy for clinical stage IB–IIB cervical cancer with pelvic and/or para-aortic lymph node metastasis between 2004 and 2008. Time to recurrence or death and patterns of disease recurrence were compared based upon the adjuvant treatment pattern: whole pelvic radiotherapy alone (n = 253), concurrent chemoradiotherapy (CCRT, n = 502) and chemotherapy alone (n = 319). Women who received chemotherapy alone had similar recurrence (5-year rates, 36.6% vs. 34.1%, adjusted-hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.70–1.28, P = 0.72) and cervical cancer mortality (24.7% vs. 21.8%, adjusted-HR 0.96, 95% CI 0.67–1.38, P = 0.83) rates compared to those who received CCRT on multivariate analysis. However, when recurrence patterns were stratified, chemotherapy treatment was independently associated with decreased risk of distant recurrence (5-year cumulative rates, 19.2% vs. 24.6%, adjusted-HR 0.47, 95% CI 0.31–0.71, P < 0.001) but increased risk of local recurrence (23.9% vs. 14.3%, adjusted-HR 2.03, 95% CI 1.34–3.08, P = 0.001) compared to CCRT. Non-squamous histology, parametrial involvement and high lymph node ratio were independent predictors for local recurrence, and presence of multiple risk factors was associated with high 5-year cumulative local recurrence rate in the chemotherapy group: no risk factor 3.9%, single factor 14.2–22.1%, and multiple risk factors 27.8–71.9% (P < 0.001). In conclusion, while exhibiting different recurrence patterns, systemic chemotherapy may be as effective a postoperative treatment as radiation-based therapy in node-positive high-risk stage IB–IIB cervical cancer. When tumor exhibits certain risk factors, chemotherapy alone is likely insufficient for local control and adding pelvic irradiation to systemic chemotherapy is recommended in this subgroup.
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作者：
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