Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy.
Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy.
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DOI：
10.1186/s12885-020-07672-w
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发表时间：
2020-11-30
期刊：
影响因子：
3.8
通讯作者：
Yaegashi N
中科院分区：
文献类型：
--
作者：
Takekuma M;Takahashi F;Mabuchi S;Kudaka W;Horie K;Ikeda M;Shikama A;Mitsuhashi A;Nagao S;Suzuki S;Mizuno M;Nishio S;Tokunaga H;Ota Y;Kasamatsu T;Kitagawa R;Toita T;Kobayashi H;Ishikawa M;Yaegashi N
本研究的目的是评价在确定性放疗（RT）/同步放化疗（CCRT）后接受挽救性子宫切除术（HT）与全身化疗（CT）治疗持续性宫颈癌患者的肿瘤学结局。回顾性分析了2005年至2014年在35家机构接受确定性RT/CCRT治疗的持续性宫颈癌患者（n = 317）。在确定性RT/CCRT后接受HT治疗持续性宫颈癌的患者与接受全身CT的患者的倾向评分相匹配。使用倾向评分匹配队列分析比较两组之间的肿瘤结局。在匹配后，共纳入了142例接受确定性RT/CCRT后的持续性宫颈癌患者（HT：71例，全身CT：71例）。HT组和CT组之间的所有背景因素平衡良好。HT组和CT组的中位总生存期分别为3.8年和1.5年（p = 0.00193，风险比[HR] 0.41，95%置信区间[CI] 0.23-0.73），残留肿瘤大小增加与高不完全切除率显著相关（p = 0.016，比值比1.11，95%CI 1.02-1.22）。HT队列中7例患者（9.9%）发生了严重晚期不良事件。目前的研究表明，与全身CT相比，在确定性RT/CCRT后采用补救性HT治疗持续性宫颈癌患者的死亡率降低约60%。这表明补救HT可能是这些患者的治愈性治疗。关于RT/CCRT后补救HT的进一步前瞻性临床试验是必要的。在线版本包含补充材料，可通过10.1186/s12885-020-07672-w获得。
The aim of the current study was to evaluate oncologic outcomes of patients who were treated with salvage hysterectomy (HT), compared to systemic chemotherapy (CT) for persistent cervical cancer after definitive radiotherapy (RT)/ concurrent chemoradiotherapy (CCRT). Patients with persistent cervical cancer treated with definitive RT/CCRT at 35 institutions from 2005 to 2014 were reviewed retrospectively (n = 317). Those who underwent a HT for persistent cervical cancer after definitive RT/CCRT were matched with propensity scores for patients who underwent systemic CT. Oncologic outcomes between the two groups using a propensity score matched–cohort analysis were compared. A total of 142 patients with persistent cervical cancer after definitive RT/CCRT were included after matching (HT: 71, systemic CT: 71). All background factors between HT and CT groups were well balanced. Median overall survival was 3.8 and 1.5 years in the HT and CT groups, respectively (p = 0.00193, hazards ratio [HR] 0.41, 95% confidence interval [CI] 0.23–0.73), Increasing residual tumor size was significantly associated with a high incomplete resection rate (p = 0.016, Odds Ratio 1.11, 95%CI 1.02–1.22). Severe late adverse events occurred in 7 patients (9.9%) in the HT cohort. The current study demonstrated that, when compared to systemic CT, the adoption of salvage HT for patients with persistent cervical cancer after definitive RT/CCRT reduced mortality rate by about 60%. This indicates that salvage HT could be curative treatment for those patients. Further prospective clinical trials with regard to salvage HT after RT/CCRT are warranted. The online version contains supplementary material available at 10.1186/s12885-020-07672-w.
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DOI：
10.1056/nejmoa1309748
发表时间：
2014-02-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
Tewari KS;Sill MW;Long HJ 3rd;Penson RT;Huang H;Ramondetta LM;Landrum LM;Oaknin A;Reid TJ;Leitao MM;Michael HE;Monk BJ
通讯作者：
Monk BJ
影响因子：
3.9
作者：
Shim, Seung-Hyuk;Kim, Soo-Nyung;Lee, Sun Joo
通讯作者：
Lee, Sun Joo
影响因子：
3.8
作者：
Fanfani, F.;Vizza, E.;Scambia, G.
通讯作者：
Scambia, G.
影响因子：
1
作者：
Mattei, Alessandra
通讯作者：
Mattei, Alessandra
影响因子：
4.7
作者：
Legge, F.;Chiantera, V.;Ferrandina, G.
通讯作者：
Ferrandina, G.