The significance of post-radiotherapy parametrial involvement and the necessity of parametrial resection in locally-recurrent or persistent cervical cancer developed after radiotherapy
The significance of post-radiotherapy parametrial involvement and the necessity of parametrial resection in locally-recurrent or persistent cervical cancer developed after radiotherapy
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DOI：
10.1016/j.jogoh.2021.102190
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发表时间：
2021-07-07
影响因子：
1.9
通讯作者：
Matsumoto, Yuri
中科院分区：
文献类型：
--
作者：
Mabuchi, Seiji;Shimura, Kotaro;Matsumoto, Yuri
目的：回顾性分析放疗后局部复发或持续性宫颈癌患者宫旁浸润（PMI）的预后意义、宫旁切除的必要性以及最佳挽救手术。方法：确定了在先前照射区域发生复发性或持续性宫颈癌并随后接受挽救性手术治疗的患者，并首次研究了放疗后PMI对患者生存的预后影响。然后，最佳的挽救手术的患者放疗后PMI以及预测放疗后PMI.Results：共60例患者接受挽救手术复发或持续的疾病进行了评估。其中，21例（35.0%）显示放疗后PMI（PMI组）。PMI组患者的无进展生存期（PFS）显著短于非PMI组（p = 0.01）。在PMI组和非PMI组中，PFS受挽救手术的完整性影响。在非PMI组中，较不彻底的手术与较彻底的手术获得了相似的治疗疗效（3年PFS率：62.5% vs 54.1%，p = 0.91）。相比之下，在PMI组中，不是较不彻底的手术而是更彻底的手术获得了治愈性治疗效果（3年PFS率：0% vs 28.9%）。最大肿瘤直径，深间质浸润，LVSI被发现是预测放疗后PMI.Conclusion：放疗后PMI是一个指标，短期生存后，挽救手术的局部复发或持续性宫颈癌患者放疗后发展。对于放疗后无PMI的患者，只要肿瘤切除范围足够，无论是小范围手术还是大范围手术都有疗效。因此，子宫切除术的类型应根据放疗后PMI的风险进行调整。(C)2021年由Elsevier Masson SAS出版。
Objective: To retrospectively evaluated the prognostic significance of post-radiotherapy parametrial involvement (PMI), the necessity of parametrial resection, and the optimal salvage surgery in locally recurrent or persistent cervical cancer developed after radiotherapy.Methods: Patients who developed recurrent or persistent cervical cancer in a previously irradiated field and were subsequently treated with salvage surgery were identified, and the prognostic impact of postradiotherapy PMI on patient's survival was first investigated. Then, the optimal salvage surgery for patients with post-radiotherapy PMI as well as the predictors for post-radiotherapy PMI were evaluated.Results: A total of 60 patients underwent salvage surgery for recurrent or persistent diseases. Of these, 21 (35.0%) showed post-radiotherapy PMI (PMI-group). Patients in PMI-group showed significantly shorter progression-free survival (PFS) than those in non-PMI-group (p = 0.01). In both PMI-group and non-PMI-group, PFS was affected by the completeness of salvage surgery. In non-PMI-group, less radical surgery achieved similar therapeutic efficacy to more radical surgery (3-year PFS rates: 62.5% versus 54.1%, p = 0.91). In contrast, in PMI-group, not less radical surgery but more radical surgery achieved curative therapeutic efficacy (3-year PFS rate: 0% versus 28.9%). Maximum tumor diameter, deep stromal invasion, and LVSI were found to be predictors of post-radiotherapy PMI.Conclusion: Post-radiotherapy PMI is an indicator of short survival after salvage surgery in patients with locally recurrent or persistent cervical cancer developed after radiotherapy. Both less radical and more radical surgery have curative therapeutic efficacies in patients without post-radiotherapy PMI, if the tumor could be resected with an adequate surgical margin. Thus, hysterectomy type should be tailored to the risk for post-radiotherapy PMI. (C) 2021 Published by Elsevier Masson SAS.