Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy
Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy
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DOI：
10.1111/j.1365-2354.2007.00831.x
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发表时间：
2008-03-01
影响因子：
2.1
通讯作者：
Chen, T. -H.
中科院分区：
文献类型：
--
作者：
Liu, M. -T.;Hsu, J. -C.;Chen, T. -H.
本研究的目的是探讨可能影响患者生存的临床和组织学特征，并评估术后辅助治疗对IB和IIA期宫颈癌患者预后的影响。140例国际妇产科联盟IB和IIA期宫颈癌患者接受了根治性子宫切除术和术后子宫切除术。手术盆腔放射治疗伴或不伴化疗。中位年龄为55岁（范围：29-86岁）。76例患者为IB期，64例患者为IIA期疾病。44< 4 cm in 96 patients and >例患者的肿瘤大小≥ 4 cm。111例患者的组织学类型为鳞状细胞癌，12例患者为腺癌，17例患者为其他组织学类型。20例患者间质浸润深度< 2/3，120例患者间质浸润深度>= 2/3。23例患者有宫旁浸润，117例患者无宫旁浸润。13例有淋巴血管间隙侵犯，127例无淋巴血管间隙侵犯。手术切缘阳性9例，切缘阴性131例。27例患者有盆腔淋巴结转移，113例患者无盆腔淋巴结转移。同期放化疗组75例，单纯放疗组65例，5年总生存率83%，无瘤生存率72%。在对数秩检验中，肿瘤大小（P = 0.0235），宫旁侵犯（P = 0.0121），盆腔淋巴结转移（P < 0.0001）和辅助化疗+放疗（P = 0.0119）是OAS的重要预后因素，有利于肿瘤大小< 4 cm，无宫旁浸润和盆腔淋巴结转移，以及接受辅助放化疗的患者。放疗联合化疗组5年OAS发生率为90%，单纯放疗组为76%，高危早期宫颈癌行根治性子宫切除术和盆腔淋巴结清扫术患者术后辅助放化疗的生存率明显高于单纯放疗组。建议在放疗的基础上增加每周一次的顺铂。治疗相关的发病率是可耐受的。
The purpose of this study is to investigate the clinical and histological features that may affect the survival of the patients and to evaluate the impact of post-operative adjuvant therapy on the outcomes of patients with stage IB and IIA carcinoma of the cervix.From August 1998 to January 2005, 140 patients with International Federation of Gynecology and Obstetrics stage IB and IIA cervical cancer were treated with radical hysterectomy and post-operative pelvic radiation therapy with or without chemotherapy. The median age was 55 years (range, 29-86 years). Seventy-six patients had stage IB and 64 patients had stage IIA disease. Tumour size was < 4 cm in 96 patients and >= 4 cm in 44 patients. One hundred and eleven patients had histology of squamous cell carcinoma, 12 patients has adenocarcinoma and 17 patients had other histologic types. Depth of stromal invasion was < 2/3 in 20 patients and >= 2/3 in 120 patients. Twenty-three patients had parametrial invasion and 117 patients had no parametrial invasion. Thirteen patients had lymphovascular space invasion and 127 had no lymphovascular space invasion. Nine patients had positive surgical margin and 131 patients had negative margin. Twenty-seven patients had pelvic lymph node metastasis and 113 patients had no pelvic lymph node metastasis. Seventy-five patients received concurrent chemoraditherapy and 65 patients received radiotherapy alone.The 5-year overall survival (OAS) and disease-free survival were 83% and 72% respectively. In the log rank test, tumour size (P = 0.0235), pararmetrial invasion (P = 0.0121), pelvic lymph node metastasis (P < 0.0001) and adjuvant chemotherapy + radiotherapy (P = 0.0119) were significant prognostic factors for OAS, favouring tumour size < 4 cm, absence of parametrial invasion and pelvic lymph node metastasis, and those who received adjuvant chemoradiotherapy. The patients who received radiation with concomitant chemotherapy had a 5-year OAS rate of 90% versus those who received radiotherapy alone, with a rate of 76%.For patients with high-risk early stage cervical cancer who underwent a radical hysterectomy and pelvic lymphadenectomy, adjuvant chemoradiotherapy resulted in better survival than radiotherapy alone. The addition of weekly cisplatin to radiotherapy is recommended. The treatment-related morbidity is tolerable.