Distefano Mariagrazia, Ferrandina Gabriella, Smaniotto Daniela, Margariti Alessandro Pasquale, Zannoni Gianfranco, Macchia Gabriella, Manfredi Riccardo, Mangiacotti Maria Grazia, Cellini Numa, Scambia Giovanni
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Oncology. 2004;67(2):103-11. doi: 10.1159/000080995.
We have updated our findings on the efficacy of concomitant radiochemotherapy plus radical surgery in a larger series of patients (n = 54) with locally advanced cervical cancer (LACC). We also investigated the role of cyclooxygenase-2 (COX-2) in this clinical setting.
Radiotherapy was administered to the whole pelvic region (1.8 Gy/day, totaling 39.6 Gy) in combination with cisplatin (20 mg/m2) and 5-fluorouracil (1,000 mg/m2) (both on days 1-4 and 27-30). Radical surgery was performed 5-6 weeks after the end of treatment.
A clinical complete or partial response was observed in all 53 evaluable patients (75.5 and 24.5%, respectively). At pathological examination, 23 of 51 patients (45.1%) undergoing radical surgery showed complete response to treatment, 18 patients (35.3%) only had microscopic residual disease, 6 patients (11.7%) had a partial response and 4 (7.8%) had no change in their disease. When logistic regression was applied, the FIGO stage (chi2 = 5.28, p = 0.021) and tumor to stroma COX-2 ratio (chi2 = 4.72, p = 0.029) retained an independent role in the prediction of the pathologic response to treatment. The 3-year disease-free survival (DFS) was 75.2%, with local relapse-free survival of 86.2% and metastasis-free interval of 89.9% at 3 years. Cases with a high COX-2 ratio showed a shorter DFS than cases with a low COX-2 ratio (p = 0.016). A direct association was shown between COX-2 ratio values and risk of recurrence, as assessed by Cox analysis using COX-2 ratio values as a continuous covariate (chi2 = 3.94, p = 0.047).
This study confirms the possibility of achieving a very high rate of pathological responses in LACC patients administered chemoradiation plus surgery (3-year DFS 75.2%). Moreover, COX-2 status may play a role in the prognostic characterization and prediction of tumor response.
我们更新了关于同步放化疗联合根治性手术治疗更大系列（n = 54）局部晚期宫颈癌（LACC）患者疗效的研究结果。我们还研究了环氧合酶-2（COX-2）在这种临床情况下的作用。
对整个盆腔区域进行放疗（1.8 Gy/天，总计39.6 Gy），同时联合顺铂（20 mg/m²）和5-氟尿嘧啶（1000 mg/m²）（均在第1 - 4天和第27 - 30天）。治疗结束后5 - 6周进行根治性手术。
在所有53例可评估患者中观察到临床完全或部分缓解（分别为75.5%和24.5%）。病理检查时，51例接受根治性手术的患者中有23例（45.1%）显示对治疗完全缓解，18例患者（35.3%）仅有微小残留病灶，6例患者（11.7%）有部分缓解，4例患者（7.8%）疾病无变化。应用逻辑回归分析时，国际妇产科联盟（FIGO）分期（χ² = 5.28，p = 0.021）和肿瘤与基质COX-2比值（χ² = 4.72，p = 0.029）在预测治疗的病理反应方面具有独立作用。3年无病生存率（DFS）为75.2%，3年局部无复发生存率为86.2%，无转移间期为89.9%。COX-2比值高的病例DFS短于COX-2比值低的病例（p = 0.016）。通过将COX-2比值作为连续协变量进行Cox分析评估，COX-2比值值与复发风险之间存在直接关联（χ² = 3.94，p = 0.047）。
本研究证实了放化疗联合手术治疗的LACC患者实现非常高的病理反应率的可能性（3年DFS为75.2%）。此外，COX-2状态可能在肿瘤反应的预后特征和预测中起作用。
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